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(409) Breaking the myth of malingering in chronic pain sufferers
P78 (408) Withdrawn by author
Abstracts
Other (410) Geographic differences and validation of prescription opioid abuse rates: A multi-data stream analysis S Butler, J Brownstein, A Licari, S Budman; Inflexxion, Inc., Newton, MA As researchers strive to characterize abuse of prescription opioids in the United States, it becomes increasingly clear that there are significant geographic differences in abuse rates throughout the country. Abuse rates of prescription opioids vary across states and within states. The National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO) is a national monitoring system for prescription drug abuse that allows timely access to prescription abuse data for pharmaceutical companies, regulatory authorities, and researchers. The NAVIPPRO system integrates data from multiple sources to provide real-time, ongoing surveillance of opioid products. One data source unique to NAVIPPRO is ASI-MV Connect, a web-enabled computer program that collects selfreported, product-specific data from patients entering substance abuse treatment programs. Patients’ home three-digit zip codes are obtained, allowing reasonably precise geospatial analysis of abuse rates of prescription opioids in general, different opioid compounds, and specific products. As of this writing, the ASI-MV Connect system contains data from 17,041 admissions; representing 227 three-digit zip codes and spanning a timeframe from November 2005 to October 2007. Seventeen percent of all substance abuse patients in this dataset admit to abusing prescription opioids in the 30 days prior to the assessment. Localized abuse rates (at the patient’s home three-digit zip code) as detected by the ASI-MV Connect system varied widely, from 0% to 64% of admissions abusing prescription opioids. Regional variations are described and compared with volume prescription data from Automation of Reports and Consolidated Orders System (ARCOS) and poison control center data obtained from American Association of Poison Control Centers (AAPCC). Examination of abuse data from multiple datasets and at finegrained geographic resolution is invaluable for monitoring abuse of prescription drugs, as well as developing and implementing interventions. Research supported by grants from the National Institute on Drug Abuse. NAVIPPRO is supported by Alpharma Pharmaceuticals, LLC and Endo Pharmaceuticals.
Pain Services–Chronic (409) Breaking the myth of malingering in chronic pain sufferers K Robinson, J Monsivais; The University of Texas at El Paso, El Paso, TX Insurance companies attribute chronic pain to malingering when complaints remain unexplained by physical evidence or lack a definitive cause. Likewise, clinical journals apprise providers to suspect malingering when patients seek compensation for injury or when pain is unconfirmed via objective evidence, judged disproportionate to the cause, or recalcitrant to treatment. Suspicions or claims of malingering may prejudice treatment or reimbursement decisions. The purpose of this archival study is to describe the psychological profile and identify malingering in a predominantly Hispanic, worker’s compensation population seeking treatment for pain. The authors used a correlational, archival research design to collect data from the medical records of 91 patients treated over a ten-year period in a specialty clinic. Inclusion criteria included individuals with a multidimensional psychological evaluation for persistent pain that affected function. Using a priori power analysis for a medium effect size, power of .80, and alpha of .05, data from 85 medical records were necessary to meet correlational significance. The study sample reflects the ethnicity, educational level, and socioeconomic status of the larger US-Mexico border community. The majority (93%) had worker’s compensation and about one-third had active litigation. At the time of the first visit, the mean age was 43 years with pain lasting an average of 3.5 years and rated at a median level of 7 (VAS). Depression coexisted with chronic pain and patients reported serious impairment in physical, occupational, and social functioning an average of 5 years after the onset of chronic pain. However, the vast majority of patients (85/91) returned to work. Although symptom magnification was common, malingering was absent. Odds ratio for return to work indicated no difference based on gender, ethnicity, litigation status, or prior history of mental distress. With adequate psychosocial support and pain treatment, individuals with chronic pain return to work.
(411) Viral spread of prescription opioid administration techniques via Internet message boards S Butler, J Dickinson, C Benoit, S Budman; Inflexxion, Inc., Newton, MA Post-marketing surveillance of potentially abusable prescription medications is increasingly considered a component of Risk Minimization Action Plans. Internet monitoring may be an important source of ‘leading edge’ data, comprising part of an ‘early warning’ system. Some prescription drug abusers use the Internet to share experiences, preferences, extraction methods, and warnings. An example of such early warning is the viral spread of administration techniques among users of Internet message boards. Several drug-related bulletin boards were searched to identify posts pertaining to the preparation and/or administration of an opioid via an aerosol solution administered intranasally. This search yielded a total of 48 posts since January 1, 2007. In September 2007, there was an increase in the number of posts about the administration of opioids via nasal saline solution. A post describing the preparation of an extended-release formulation of morphine sulfate on September 11, 2007 appears to be the index case for much of the resulting discussion. This post generated a response from an individual who claimed to use this method of administration with fentanyl, which was followed by a post requesting detailed instructions on making fentanyl nasal spray. These instructions were posted the same day. Several days later, on another website, similar instructions for the preparation of fentanyl were posted by a username used on both websites. The Internet is an ideal tool for individuals involved in drug abuse, allowing unfettered and anonymous exchange of ideas and knowledge among and between people who may otherwise be geographically isolated. The exchange observed in this case illustrates how dissemination of a single idea can spread to other substances and other websites, potentially reaching an increasing number of abusers and affecting drug abuse in the population at large. Research supported by grants from the National Institute on Drug Abuse, Alpharma Pharmaceuticals, LLC and Endo Pharmaceuticals.
Abstracts
Other (410) Geographic differences and validation of prescription opioid abuse rates: A multi-data stream analysis S Butler, J Brownstein, A Licari, S Budman; Inflexxion, Inc., Newton, MA As researchers strive to characterize abuse of prescription opioids in the United States, it becomes increasingly clear that there are significant geographic differences in abuse rates throughout the country. Abuse rates of prescription opioids vary across states and within states. The National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO) is a national monitoring system for prescription drug abuse that allows timely access to prescription abuse data for pharmaceutical companies, regulatory authorities, and researchers. The NAVIPPRO system integrates data from multiple sources to provide real-time, ongoing surveillance of opioid products. One data source unique to NAVIPPRO is ASI-MV Connect, a web-enabled computer program that collects selfreported, product-specific data from patients entering substance abuse treatment programs. Patients’ home three-digit zip codes are obtained, allowing reasonably precise geospatial analysis of abuse rates of prescription opioids in general, different opioid compounds, and specific products. As of this writing, the ASI-MV Connect system contains data from 17,041 admissions; representing 227 three-digit zip codes and spanning a timeframe from November 2005 to October 2007. Seventeen percent of all substance abuse patients in this dataset admit to abusing prescription opioids in the 30 days prior to the assessment. Localized abuse rates (at the patient’s home three-digit zip code) as detected by the ASI-MV Connect system varied widely, from 0% to 64% of admissions abusing prescription opioids. Regional variations are described and compared with volume prescription data from Automation of Reports and Consolidated Orders System (ARCOS) and poison control center data obtained from American Association of Poison Control Centers (AAPCC). Examination of abuse data from multiple datasets and at finegrained geographic resolution is invaluable for monitoring abuse of prescription drugs, as well as developing and implementing interventions. Research supported by grants from the National Institute on Drug Abuse. NAVIPPRO is supported by Alpharma Pharmaceuticals, LLC and Endo Pharmaceuticals.
Pain Services–Chronic (409) Breaking the myth of malingering in chronic pain sufferers K Robinson, J Monsivais; The University of Texas at El Paso, El Paso, TX Insurance companies attribute chronic pain to malingering when complaints remain unexplained by physical evidence or lack a definitive cause. Likewise, clinical journals apprise providers to suspect malingering when patients seek compensation for injury or when pain is unconfirmed via objective evidence, judged disproportionate to the cause, or recalcitrant to treatment. Suspicions or claims of malingering may prejudice treatment or reimbursement decisions. The purpose of this archival study is to describe the psychological profile and identify malingering in a predominantly Hispanic, worker’s compensation population seeking treatment for pain. The authors used a correlational, archival research design to collect data from the medical records of 91 patients treated over a ten-year period in a specialty clinic. Inclusion criteria included individuals with a multidimensional psychological evaluation for persistent pain that affected function. Using a priori power analysis for a medium effect size, power of .80, and alpha of .05, data from 85 medical records were necessary to meet correlational significance. The study sample reflects the ethnicity, educational level, and socioeconomic status of the larger US-Mexico border community. The majority (93%) had worker’s compensation and about one-third had active litigation. At the time of the first visit, the mean age was 43 years with pain lasting an average of 3.5 years and rated at a median level of 7 (VAS). Depression coexisted with chronic pain and patients reported serious impairment in physical, occupational, and social functioning an average of 5 years after the onset of chronic pain. However, the vast majority of patients (85/91) returned to work. Although symptom magnification was common, malingering was absent. Odds ratio for return to work indicated no difference based on gender, ethnicity, litigation status, or prior history of mental distress. With adequate psychosocial support and pain treatment, individuals with chronic pain return to work.
(411) Viral spread of prescription opioid administration techniques via Internet message boards S Butler, J Dickinson, C Benoit, S Budman; Inflexxion, Inc., Newton, MA Post-marketing surveillance of potentially abusable prescription medications is increasingly considered a component of Risk Minimization Action Plans. Internet monitoring may be an important source of ‘leading edge’ data, comprising part of an ‘early warning’ system. Some prescription drug abusers use the Internet to share experiences, preferences, extraction methods, and warnings. An example of such early warning is the viral spread of administration techniques among users of Internet message boards. Several drug-related bulletin boards were searched to identify posts pertaining to the preparation and/or administration of an opioid via an aerosol solution administered intranasally. This search yielded a total of 48 posts since January 1, 2007. In September 2007, there was an increase in the number of posts about the administration of opioids via nasal saline solution. A post describing the preparation of an extended-release formulation of morphine sulfate on September 11, 2007 appears to be the index case for much of the resulting discussion. This post generated a response from an individual who claimed to use this method of administration with fentanyl, which was followed by a post requesting detailed instructions on making fentanyl nasal spray. These instructions were posted the same day. Several days later, on another website, similar instructions for the preparation of fentanyl were posted by a username used on both websites. The Internet is an ideal tool for individuals involved in drug abuse, allowing unfettered and anonymous exchange of ideas and knowledge among and between people who may otherwise be geographically isolated. The exchange observed in this case illustrates how dissemination of a single idea can spread to other substances and other websites, potentially reaching an increasing number of abusers and affecting drug abuse in the population at large. Research supported by grants from the National Institute on Drug Abuse, Alpharma Pharmaceuticals, LLC and Endo Pharmaceuticals.