Ongoing Assessment Tools

As previously mentioned, risk assessment tools measure essential characteristics associated with addiction in chronic pain populations. Since physical dependence and tolerance occur in most patients on long-term opioid therapies, other factors must be taken into account to identify those who suffer from addiction.

It can be a challenging task for clinicians to determine whether a chronic pain patient, who is physically dependent upon prescription opioids for pain management, is in fact addicted to those medications. In a long-term therapeutic situation where physical dependence does not necessarily signify abuse, ongoing assessment tools can aid clinicians in identifying those patients who are abusing.

Ongoing assessment tools are used throughout opioid treatment for chronic pain to monitor the patient's progress and prevent abuse of medication. They identify current misuse in patients already on opioids. Frequent use of the tool as a monitoring system should alert the clinician to early aberrant changed in the patient's behavior, and minimize the damaging effects of addiction in the patient's life. Every ongoing assessment tool varies in terms of criteria, length, target population and context. If an addictive disease is identified by the clinician, it must be aggressively managed. The clinician should take steps to address the addiction issues, whether through treatment changes, referrals or increased monitoring.

This section focuses on the following widely used ongoing assessment tools: COMM, ABC, Chabal 5-Point Checklist, PMQ, PDUQ, and PADT.

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Compton P, Darakjian J, Miotto K. Screening for addiction in patients with chronic pain and “problematic” substance use: evaluation of a pilot assessment tool. J Pain Symptom Manage. 1998; 16: 355-363. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9879160 Accessed on: 2013-09-12.