Doctors could consider adding a psychosocial evaluation to their assessment of a patient's risk of opioid misuse, a new study suggests.
Emotional instability, in particular, significantly predicted risk assessment scores, the researchers reported last week in Las Vegas at a large pain conference.
"Personality assessment can really help flesh out what conditions put patients at greatest risk of misuse and potentially overdose," Dr Geralyn Datz told Reuters Health. Dr Datz, a psychologist at Forrest General Hospital in Hattiesburg, Mississippi, led the new study.
Researchers already knew that undetected psychiatric conditions can contribute to medication misuse. This study shows that unstable emotions and traits associated with borderline personality disorder, specifically, may increase the risk of misuse.
Impulsiveness highlights the risk
Dr Datz and her team assessed 96 outpatients with both a psychiatric evaluation and an opioid risk assessment, the Millon Behavioral Medicine Diagnostic and the Screener and Opioid Assessment for Patients with Pain-Revised.
Adjusting for age, gender, duration of pain and the number of pain sites, multiple regression analysis found that psychiatric indicators accounted for 42.7% of the variance in the risk assessment score. Emotional instability and the number of pain sites predicted risk over other psychiatric factors.
Impulsiveness and an impaired decision-making ability could underlie the heightened risk, Dr Datz suspects. But, she says, further study is needed.
Dr Todd Sitzman, medical director of the Advanced Pain Therapy treatment centre in Hattiesburg, who was also involved in the study, said, "If some personality traits are correlated with aberrant behaviours and risk of misuse of medication, I'd certainly want to know about it in my practice."
Limits for patients
"The outcomes do not mean that I will not prescribe to my patients, but they will heighten my vigilance and I will be stricter in my follow up," he said.
Dr Sitzman recommends setting limits for patients with high-risk profiles, including people with traits of borderline personality disorder, and that clinicians inform their staff to adhere to those limits as well.
"But in no way should any single psychological or psychometric test preclude the prescription of medicine to a patient who needs analgesic therapy," Dr Sitzman says.
(Reuters Health, September 2011)