Cross-Validation of a Screener to Predict Opioid Misuse in Chronic Pain Patients (SOAPP-R)

There has been a growing use of opioids for the treatment of chronic pain, especially for chronic, noncancer pain, and due, in part, to this growth, increasing notice has been given to the abuse of prescription opioid medication 1, 2. Opioids can be an effective treatment for chronic pain, yet providers are reluctant to prescribe opioids because of concerns over tolerance, dependence, and addiction. Some pain centers where opioids are prescribed have been overwhelmed with patients seeking pain medication for purposes other than to control their pain or to control their pain in ways not medically prescribed, and many physicians prescribing pain medication have little training to deal with addiction or in dealing with aberrant medication-related behavior 3. In a survey of primary care physicians, one-third of respondents indicated that they would not, under any circumstance, prescribe opioids to patients with chronic, noncancer pain 4, 5. However, seventy percent of these same physicians indicated that this type of pain is usually inadequately treated 4, 5. Clinicians continuously identify the need for additional opioid risk management tools and training to objectively assess and monitor chronic pain patients being considered for opioid therapy. The Screener and Opioid Assessment for Patients with Pain - Revised (SOAPP-R)6 was developed to complement current risk assessment practices and to improve a clinician’s ability to assess a patient’s risk for opioid abuse. The SOAPP-R addresses some of the limitations of the original SOAPP V.1. The SOAPP-R was empirically, rather than conceptually, derived; it was validated in a more systematic fashion and it contains more subtle items and items that do not require admission of socially unacceptable behaviors. The SOAPP-R was found to have good psychometric properties in a test with 284 chronic pain patients on long-term opioid therapy. Classical test development methods require that the primary reliability and validity be confirmed in a cross-validation study 7. Any validity coefficient computed on a given sample can be spuriously high since such values capitalize on random sampling errors within the particular sample. It is expected that the validity and reliability parameters will “shrink” when tested on a new sample, however, the scale should still remain valid and reliable. Cross-validation reflects a high, but necessary standard for any assessment where the results may impact important clinical decisions. The purpose of this study was to cross-validate the SOAPP-R with a new sample of chronic, noncancer pain patients.