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Systematic review to determine which validated measurement tools can be used to assess risk of problematic analgesic use in patients with chronic pain

First published: 10 May 2019 | Last updated: 20 May 2019

Aims: Chronic pain is a common problem, and there is growing awareness of risks associated with prescribing of analgesics. Misuse of prescription opioids, and of other analgesic drugs, notably gabapentinoids, has increased. A number of tools have been developed to predict those more at risk of problem use. This review was undertaken to determine which validated measurement tools can be used to assess this risk in patients with chronic pain, either prior, or during, treatment. Analgesics included opioids, gabapentinoids and tricyclic antidepressants.

Design: Selected databases (Embase, Medline, Cochrane library/CENTRAL, PsycINFO, PubMed, CINAHL) were systematically searched, using selected inclusion/ exclusion criteria and a reproducible search strategy. Two independent reviewers reviewed abstracts, then full texts of selected studies to extract data and assess quality.

Setting: Primary & secondary healthcare providers

Participants: Adults (18 and over) with a diagnosis of chronic pain (pain persisting for more than 3 months), where analgesic medication was prescribed or under consideration

Measurements: 1844 abstracts were identified, and 34 studies selected for inclusion after initial selection and review of bibliographies of selected studies. All identified or predicted problematic use of opioids rather than gabapentinoids or tricyclic antidepressants, for which no studies were found. Meta-analysis was not undertaken given the heterogeneity in definitions and methods between studies.

Findings & Conclusions: 14 tools were identified, with 17 studies presenting or evaluating tools that aimed to predict future misuse; 5 measuring current misuse; 4 claiming to do both; 3 comparing different measures; and 2 describing tools that largely monitored use. In addition, 3 systematic reviews were identified. Advantages and limitations were discussed, as well as the need for validation of existing tools in different populations, and further development of tools to predict misuse of other analgesics including gabapentinoids.

Co-Authors

Professor Lesley Colvin, University of Edinburgh Dr Daniel Mogford, NHS Lothian

Conflicts of interest:

Funding Sources: None

No conflict of interest

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Report Author

Rebecca Lawrence

Consultant Psychiatrist


Dr Rebecca Lawrence studied medicine at Edinburgh University, graduating MBChB in 1988. She then undertook General Practice training (MRCGP 1996) before commencing training in General Psychiatry in South East Scotland (MRCPsych 2000, CCST with endorsement in addictions 2005).  She has an interest in the history of psychiatry and her MPhil thesis was entitled The Roxburgh, Berwick, and Selkirk District Asylum. A study of patients admitted from 1887 to 1897. She has worked as a consultant psychiatrist in addictions since 2005, firstly in the Scottish Borders, and in Edinburgh and the Lothians since 2006. She is the lead consultant for the specialist in-patient addictions unit in Edinburgh, and works with LEAP (Lothians and Edinburgh Abstinence Programme), as well as having a special interest in pain management through her outpatient work in the Lothian Pain and Dependency Clinic. She is currently undertaking an MSc in Clinical Management of Pain (University of Edinburgh), and is a co-investigator in a multi-site observational study of the side effects of opioids (SEOS). She is active in teaching and training, and is the local teaching lead for addictions for medical students. She is a medical examiner and supervisor for the GMC, and has a particular interest, both personally and professionally, in doctors’ health and supporting doctors in difficulties.

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