title: The Contribution of Differential Opioid Responsiveness to Identification of Opioid Risk in Chronic Pain Patients.
abstract: The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) predicts increased risk of opioid misuse in chronic pain patients. We evaluated whether higher SOAPP-R scores are associated with greater opioid reinforcing properties, potentially contributing to their predictive utility. Across 2 counterbalanced laboratory sessions, 55 chronic low back pain sufferers completed the SOAPP-R at baseline and measures of back pain intensity, evoked pain responsiveness (thermal, ischemic), and subjective opioid effects after receiving intravenous morphine (.08 mg/kg) or saline placebo. Morphine effect measures were derived for all outcomes, reflecting the difference between morphine and placebo condition values. Higher SOAPP-R scores were significantly associated with greater desire to take morphine again, less feeling down and feeling bad, and greater reductions in sensory low back pain intensity following morphine administration. This latter effect was due primarily to SOAPP-R content assessing medication-specific attitudes and behavior. Individuals exceeding the clinical cutoff (18 or higher) on the SOAPP-R exhibited significantly greater morphine liking, desire to take morphine again, and feeling sedated; less feeling bad; and greater reductions in sensory low back pain following morphine. The SOAPP-R may predict elevated opioid risk in part by tapping into individual differences in opioid reinforcing effects.
  
  
  CONCLUSIONS
  Based on placebo-controlled morphine responses, associations were observed between higher scores on a common opioid risk screener (SOAPP-R) and greater desire to take morphine again, fewer negative subjective morphine effects, and greater analgesia. Opioids may provide the best analgesia in those patients at greatest risk of opioid misuse.
authors.affiliation: Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee. Electronic address: Stephen.Bruehl@vanderbilt.edu.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bruehl
authors.affiliation: Department of Behavioral Science, Rush University, Chicago, Illinois.
authors.forename: John W
authors.initials: JW
authors.lastname: Burns
authors.affiliation: Millennium Research Institute, San Diego, California.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Passik
authors.affiliation: Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Anesthesiology, Rush University, Chicago, Illinois.
authors.forename: Asokumar
authors.initials: A
authors.lastname: Buvanendran
authors.affiliation: Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Melissa
authors.initials: M
authors.lastname: Chont
authors.affiliation: Department of Behavioral Science, Rush University, Chicago, Illinois.
authors.forename: Erik
authors.initials: E
authors.lastname: Schuster
authors.affiliation: Department of Behavioral Science, Rush University, Chicago, Illinois.
authors.forename: Daria
authors.initials: D
authors.lastname: Orlowska
authors.affiliation: Department of Psychology, Ohio University, Athens, Ohio.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: France
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects*; D009270:Naloxone / Q000008:administration & dosage; D009292:Narcotic Antagonists / Q000008:administration & dosage; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000209:etiology*; D010147:Pain Measurement; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D009020:Morphine
keywords: Opioid; abuse risk; analgesia; chronic pain; misuse; personalized medicine; screening