An Evaluation of the Predictive Validity of the Pain Medication Questionnaire With a Heterogeneous Group of Chronic Pain Patients

The Pain Medication Questionnaire (PMQ) was initially developed by Adams and colleagues (2004) as a 26-item self-report assessment to screen for opioid medication misuse. The PMQ has demonstrated good reliability and validity, and was predictive of early termination from treatment and identified patients who demonstrated maximal benefit from interdisciplinary treatment (Holmes et al., 2006). This current study explored whether or not the initial PMQ score would accurately predict the development of aberrant opioid medication use behaviors relative to specific behavioral indices (i.e., request for early refills, use of a medication agreement) and a physician rating of medication misuse behaviors. Patients fell into two groups according to their initial score on the PMQ based on the median score of 25. Patients with higher PMQ (H-PMQ) scores reported greater levels of perceived disability and decreased physical and mental functioning. Total scores from the PMQ were moderately correlated with initial measures of physical and psychosocial functioning, and observed problematic medication use behaviors observed by physicians during evaluation. However, higher PMQ scores did not significantly predict the use of a medication agreement or requests for early refills. Five patients were identified from the H-PMQ group that demonstrated problematic opioid medication use that fell outside of the realm of early refill requests. These included utilizing leftover pain medications, taking narcotic medication prescribed to a family member, prescription forgery, and referral for detoxification. Although these patients varied on demographic variables, they each had a PMQ total score greater than 30. Indicating that although a PMQ total score ≥ 25 is indicative of problematic use, a score ≥ 30 suggests that a patient should be closely monitored when prescribed and opioid medication. Overall, this study demonstrated that a patient's self-report is significantly correlated with problematic behaviors observed by physicians. Therefore, when utilized in a busy clinic setting, the PMQ will aide in the identification of specific problematic behaviors and beliefs at the outset of treatment that may hinder successful treatment of a patient's pain condition.