This study comprised the first step in the psychometric development of a self-report screening instrument for risk of opioid medication misuse among chronic pain patients. A 26-item instrument, the Pain Medication Questionnaire (PMQ), was constructed based on suspected behavioral correlates of opioid medication misuse, which heretofore have received limited empirical investigation. The PMQ was administered to 184 patients at an interdisciplinary pain treatment center. Reliability coefficients for the PMQ were found to be of moderate but acceptable strength. Construct and concurrent validity were examined through correlation of PMQ scores to measures of substance abuse, physical and psychological functioning, and physicians' risk assessments. To explore high and low cutoff points for misuse risk, subgroups were formed according to the upper and lower thirds of PMQ scores and compared on validity measures. Higher PMQ scores were associated with history of substance abuse, higher levels of psychosocial distress, and poorer functioning. Future psychometric analyses will consider predictive validity and examine shortened versions of the instrument.

R E S U LT S -C o m p a red with the pain VAS scores before active (6.2 ± 1.0) and sham (6.4 ± 0.9) treatments, pain scores after treatment were reduced to 2.5 ± 0.8 and 6.3 ± 1.1, re s p e c t i v e l y. With active PENS treatment, the VAS activity and sleep scores were significantly improved fro m 5.2 ± 1.0 and 5.8 ± 1.3 to 7.9 ± 1.0 and 8.3 ± 0.7, re s p e c t i v e l y. The VAS scores for pain, activi t y, and sleep were unchanged from baseline values after the sham treatments. Patients' daily oral nonopioid analgesic re q u i rements decreased by 49 and 14% after active and sham PENS t reatments, re s p e c t i v e l y. The post-treatment physical and mental components of the SF-36, the BDI, and the POMS all showed a significantly greater improvement with active versus sham t reatments. Active PENS treatment improved the neuropathic pain symptoms in all patients. C O N C L U S I O N S -PENS isa useful nonpharmacological therapeutic modality for tre a t i n g diabetic neuropathic pain. In addition to decreasing extremity pain, PENS therapy impro v e d physical activity, sense of well-being, and quality of sleep while reducing the need for oral nonopioid analgesic medication. E m e r g i n g T r e a t m e n t s a n d T e c h n o l o g i e s Diabetes Care

The proper medicinal use of opioids, in light of their notorious history and current relation to social ills, continues to be debated and remains unclear in several areas of medicine. This article will review several areas and points of controversy related to screening for potential problematic opioid behavior in chronic nonmalignant pain patients. Controversy over the prescription of opioids for chronic nonmalignant pain continues, despite the growing acceptance of this practice. Indeed, past research supports the beneficial use of opioids for noncancer pain. Unfortunately, traditional definitions of abuse and dependence, with their emphasis on tolerance and withdrawal, are inappropriate for chronic pain patients prescribed opioids. The component of traditional definitions of abuse and dependence that appears most applicable to chronic pain patients centers on the criterion that the patient continue to take the drug (in this case, the opioid) despite negative and harmful effects or despite any decrease in pain level. Although clinical observations exist about risk factors for opioid misuse in chronic pain patients, there is limited research. Further, the area of prescreening for problematic drug behavior is in its infancy. However, researchers have begun to delve into this challenging area and the application of rigorous empirical research will bring us closer to identifying those patients at risk so that their pain is managed without destructive outcomes in other areas of their life.

OBJECTIVE—To evaluate the use of percutaneous electrical nerve stimulation (PENS) in the management of patients with painful diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS—A total of 50 adult patients with type 2 diabetes and peripheral neuropathic pain openface> 6 months duration involving the lower extremities were randomly assigned to receive active PENS (needles with electrical stimulation at an alternating frequency of 15 and 30 nz) and sham (needles only) treatments for 3 weeks. Each series of treatments was administered for 30 min three times a week according to a standardized protocol. After a 1‐week washout period, all patients were subsequently switched to the other modality. A 10‐cm visual analog scale (VAS) was used to assess pain, physical activity and quality of sleep before each session. The changes in VAS scores and daily requirements for oral analgesic medication were determined during each 3‐week treatment period. Patients completed the MOS 36‐Item Short‐Form Health Survey (SF‐36), the Beck Depression Inventory (BDI), and the Profile of Mood States (POMS) before and after completion of each treatment modality. At the end of the crossover study, a patient preference questionnaire was used to compare the effectiveness of the two modalities. RESULTS—Compared with the pain VAS scores before active (6.2 +/− 1.0) and sham (6.4 +/− 0.9) treatments, pain scores after treatment were reduced to 2.5 +/− 0.8 and 6.3 +/− 1.1, respectively. With active PENS treatment, the VAS activity and sleep scores were significantly improved from 5.2 +/− 1.0 and 5.8 +/− 1.3 to 7.9 +/− 1.0 and 8.3 +/− 0.7, respectively. The VAS scores for pain, activity, and sleep were unchanged from baseline values after the sham treatments. Patient's daily oral nonopioid analgesic requirements de‐creased by 49 and 14% after active and sham PENS treatments, respectively. The post‐treatment physical and mental components of the SF‐36, the BDI, and the POMS all showed a significantly greater improvement with active versus sham treatments. Active PENS treatment improved the neuropathic pain symptoms in all patients. CONCLUSIONS—PENS is a useful nonpharmacological therapeutic modality for treating diabetic neuropathic pain. In addition to decreasing extremity pain, PENS therapy improved physical activity, sense of well‐being, and quality of sleep while reducing the need for oral nonopioid analgesic medication.

Abstract:The Pain Medication Questionnaire (PMQ) was designed to assess the risk for opioid medication misuse in chronic pain patients. A preliminary study showed a positive relationship between higher PMQ scores and concurrent measures of substance abuse, psychopathology, and physical/ life-functioning. Using a larger sample size, the present study sought to replicate these findings, and to expand upon them by examining the relationship between PMQ scores and various treatment outcomes. The PMQ was administered to 271 newly evaluated chronic pain patients who were subsequently re-evaluated immediately post-treatment, as well as six months following discharge. Subgroups were then formed according to the lowest (L-PMQ), middle (M-PMQ), and highest (H-PMQ) one-third of PMQ total scores. It was found that the H-PMQ group was 2.6 times more likely to have a known substance-abuse problem, 3.2 times more likely to request early refills of prescription medication, and 2.3 times more likely to drop out of treatment, as compared to the L-PMQ group. They also had diminished biopsychosocial functioning. In addition, at six months following discharge, patients who completed the program experienced a significant decrease in PMQ scores over time relative to those patients who were unsuccessfully discharged from the program or who dropped out. This study represents the second stage in the development of a psychometrically sound screening tool for measuring risk for opioid medication misuse among chronic pain patients, and findings suggest the long-term utility of the PMQ in identifying patients who are more likely to complete and benefit from a pain management program.