Physicians commonly use a variety of medical tests to assess patients with pain. However, they often overlook the use of psychometric questionnaires, which can be used not only to assess the psychological and social aspects of the patient, but also for the standardized assessment of pain, functioning and somatic complaints, and for tracking response to treatment. These tests have been shown to have considerable scientific value, and play an important role in the three-dimensional assessment process. As noted above, research has found that these tests can be powerful predictors of outcome, exceeding the predictive power of commonly used medical tests, such as MRI’s and discography. It follows from this that, for patients with chronic pain, psychological questionnaires should be used as routinely as MRIs and other medical assessments.
*Assessment and Treatment of Chronic Pain, John Mark Disorbio, EdD, Daniel Bruns, PsyD, and Giancarlo Barolat, MD, Practical Pain Management, March 2006
All clinicians prescribing opioids should be knowledgeable about risk factors for opioid abuse and methods for assessing risk. A thorough history and physical examination, including an assessment of psychosocial factors and family history, is essential for adequate risk stratification. The factor most strongly predictive of opioid abuse, misuse, or other aberrant drug-related behaviors is a personal or family history of alcohol or drug abuse.
*2009 Clinical Guidelines from the American Pain Society and the American Academy of Pain Medicine on the use of chronic opioid therapy in chronic noncancer pain, Roger Chou
The use of psychological assessment is emerging as an application of patient selection that is helpful in identifying patients most appropriate for opioid therapy. Several guidelines and esteemed investigators have recognized that a comprehensive, and thereby successful, opioid screening requires assessment of substance abuse, addiction potential, psychopathology, and medical compliance. In practice, this may be achieved through a combination approach including psychological assessment. Several leading researchers have recently advocated for a “universal precautions” approach to risk assessment, where psychological assessment and subsequent risk stratification is a routine part of opioid screening. RATIONALE FOR PSYCHOLOGICAL ASSESSMENT IN OPIOID THERAPY Unrecognized and untreated psychopathology can interfere with successful rehabilitation. Psychopathology increases pain intensity and disability, contributing to a negative cycle that perpetuates functional limitations. Anxiety decreases pain thresholds and tolerances, and physical symptoms can result from chronic activation of the autonomic nervous system, hypervigilance, misinterpretation, and somatic amplification. Both anxiety and depression are associated with symptom magnification, and depression is linked to poor treatment outcomes with traditional medical approaches. Psychopathology also exacerbates treatment nonadherence. Depressed patients, for example, are up to 3 times more likely to be nonadherent to physician recommendations than nondepressed patients.
*Psychological Assessment for the Prevention of Misuse in Opioid Therapy, Geralyn Datz, PhD, The Pain Practioner, Vol. 19, Number 3, pp. 25-34