Predicting Potential Risk Factors of Prescription Pain Medication Misuse in a Chronic Pain Population Through PROMIS Global Health Score
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BACKGROUND: Chronic pain patients who are treated through an interdisciplinary treatment program have shown to report less symptoms of pain by a substantial degree. (Gatchel & Okifuji, 2006) Aspects of the Biopsychosocial Model such as physical and mental health, as well as appropriate medication adherence, must be considered for treatment. This study attempts to reinforce the clinical utility of the Biopsychosocial model by illustrating differences in self-perceived physical and mental health status. Subsequently, we hope to identify the influence of mental vs. physical health on pain-behaviors. Overall we hope to find a correlation between a patient’s self-reported health, using the Global Health Status PROMIS, and predicting their likelihood to abuse prescription pain medication, as measured through the PMQ (Pain Medication Questionnaire). Successively, clinicians can target the endorsement of poor mental health and/or poor physical health as a distinct concern in reducing pain behaviors such as prescription misuse. SUBJECTS: The final sample included data from males and females evaluated for the Interdisciplinary Pain Program at the McDermott Pain Clinic at UT Southwestern Medical center. Participants who were not chosen to participate in the IPP were still included in the data set. As the McDermott Pain Clinic does not typically provide care for children and adolescents (<18 years), children and adolescents were excluded from the present study. The test groups will consist of participants between 18 and 90 years of age as referred to the program by psychologists, Dr. Travis Whitfill and Dr. Richard Robinson of UT Southwestern and capable of providing informed consent, able to read and speak English, experiencing non-malignant pain-related problems, and willing to allow access to their electronic medical records. METHOD: Participants were administered a battery of assessments including the Pain Medication Questionnaire, Global Health Status PROMIS and other established measures of health and pain-related outcomes (e.g., SF-36, PROMIS pain-related measures) at baseline RESULTS: The results in the current study suggest that the PROMIS mental health score is a significant predictor in examining the likelihood for prescription pain medication misuse. Although the predictor variables of PROMIS physical health, age and gender improved the overall variance of the model when examined as single predictors they were shown not to be significant. The first hypothesis was not supported as shown by the weak linearity in the scatter plots of PROMIS physical and PROMIS mental health scores. Surprisingly, the strength of the relationship of physical and mental health scores was not significantly correlated despite support in the literature; however, this may be due to sampling limitations. The second hypothesis was supported through findings that suggest PROMIS mental health score is a strong predictor of participants’ PMQ score. Although PROMIS physical, age and gender improved the overall fit of the model their p values were not found to be significant when examined within the model. The latter part of hypothesis two that suggested age and gender would not be significant predictors of PMQ was supported, as their p-values found were .862 for age and .058 for gender, respectively. DISCUSSION: The current study achieved its stated goals of evaluating the predictive utility of the Global Health Status PROMIS in comparison with the PMQ. The current study offers an important contribution to understanding and evaluating chronic pain and the multifaceted nature of Biopsychosocial outcomes. It is anticipated that future clinical research will continue to expand upon the implications from this study and contribute to more effective evaluation and treatment for individuals suffering from chronic pain and lend attention to risk factors of prescription pain medication misuse. Through targeting psychological elements in addition to physiological pain reduction clinicians can help reduce risk factors of detrimental pain behaviors.