Do pain patients at high risk for substance misuse experience more pain? A longitudinal outcomes study

The Screener and Opioid Assessment of Pain Patients (SOAPP v.1) has been shown to be a reliable measure of risk potential for substance misuse and to correlate with a history of substance abuse, legal problems, craving, smoking, and mood disorders among chronic pain patients. The aim of this study was to examine differences over time on a number of measures among chronic pain patients who were classified as high or low risk for opioid misuse based on scores on the SOAPP.

From an initial sample of one hundred thirty-four participants (N = 134), one hundred and ten (N = 110) completed the SOAPP and were grouped as high or low risk for misuse of medication based on SOAPP scores of > or =7. All subjects were asked to complete baseline measures and in-clinic monthly diaries of their pain, mood, activity interference, medication, and side effects over a 10-month study period.

The results showed that although those who were classified as high-risk for opioid misuse reported significantly higher levels of pain intensity, activity interference, pain catastrophizing, disability, and depressed mood at baseline (P < 0.05), only pain intensity ratings were found to differentiate groups over time (P < 0.01). These results were unrelated to perceived helpfulness of pain treatment.

Differences in subjective pain intensity were found between those who are high risk for opioid misuse compared with those at low risk for medication misuse, implying that higher-risk patients may experience more subjective pain. Consequently, these patients may be more challenging to treat.