Nikulina Valentina, Guarino Honoria, Acosta Michelle C, Marsch Lisa A, Syckes Cassandra, Moore Sarah K, Portenoy Russell K, Cruciani Ricardo A, Turk Dennis C, Rosenblum Andrew
Department of Psychology, Queens College, CUNY, Flushing, NY, USA.
National Development and Research Institutes, Inc, New York, NY, USA.
Pain. 2016 Aug;157(8):1791-1798. doi: 10.1097/j.pain.0000000000000583.
During long-term opioid therapy for chronic noncancer pain, monitoring medication adherence of patients with a history of aberrant opioid medication-taking behaviors (AMTB) is an essential practice. There is limited research, however, into the concordance among existing monitoring tools of self-report, physician report, and biofluid screening. This study examined associations among patient and provider assessments of AMTB and urine drug screening using data from a randomized trial of a cognitive-behavioral intervention designed to improve medication adherence and pain-related outcomes among 110 opioid-treated patients with chronic pain who screened positive for AMTB and were enrolled in a pain program. Providers completed the Aberrant Behavior Checklist (ABC) and patients completed the Current Opioid Misuse Measure (COMM) and the Chemical Coping Inventory (CCI). In multivariate analyses, ABC scores were compared with COMM and CCI scores, while controlling for demographics and established risk factors for AMTB, such as pain severity. Based on clinical cutoffs, 84% of patients reported clinically significant levels of AMTB and providers rated 36% of patients at elevated levels. Provider reports of AMTB were not correlated with COMM or CCI scores. However, the ABC ratings of experienced providers (nurse practitioners/attending physicians) were higher than those of less experienced providers (fellows) and were correlated with CCI scores and risk factors for AMTB. Associations between patient- and provider-reported AMTB and urine drug screening results were low and largely nonsignificant. In conclusion, concordance between patient and provider reports of AMTB among patients with chronic pain prescribed opioid medication varied by provider level of training.
在针对慢性非癌性疼痛的长期阿片类药物治疗期间，监测有异常阿片类药物用药行为（AMTB）病史患者的药物依从性是一项基本操作。然而，关于现有自我报告、医生报告和生物流体筛查监测工具之间的一致性研究有限。本研究利用一项认知行为干预随机试验的数据，检验了患者和提供者对AMTB的评估与尿液药物筛查之间的关联。该试验旨在改善110名接受阿片类药物治疗的慢性疼痛患者的药物依从性和疼痛相关结局，这些患者AMTB筛查呈阳性并参加了一个疼痛项目。提供者完成异常行为检查表（ABC），患者完成当前阿片类药物滥用测量表（COMM）和化学应对量表（CCI）。在多变量分析中，比较了ABC评分与COMM和CCI评分，同时控制人口统计学因素和已确定的AMTB风险因素，如疼痛严重程度。根据临床临界值，84%的患者报告有临床显著水平的AMTB，提供者将36%的患者评为高水平。提供者对AMTB的报告与COMM或CCI评分无关。然而，经验丰富的提供者（执业护士/主治医生）的ABC评分高于经验不足的提供者（研究员），并且与CCI评分和AMTB风险因素相关。患者和提供者报告的AMTB与尿液药物筛查结果之间的关联较低且大多无统计学意义。总之，在开具阿片类药物的慢性疼痛患者中，患者和提供者报告的AMTB之间的一致性因提供者的培训水平而异。
