© 2006 World Institute of Pain, 1530-7085/06/$15.00 Pain Practice, Volume 6, Issue 2, 2006 74–88 Blackwell Publishing IncMalden, USAPPRPain Practice1530-70852006 World Institute of Pain2006 627488Original ArticleRisk of Opioid Misuse and Treatment OutcomesHOLMES ET AL. Address correspondence and reprint requests to: Robert J. Gatchel, PhD, ABPP, Department of Psychology, College of Science, University of Texas at Arlington, 313 Life Science Building, Arlington, TX 76019-0528, U.S.A. E-mail: gatchel@uta.edu. Submitted: December 14, 2005; Accepted: January 20, 2006 ORIGINAL ARTICLE An Opioid Screening Instrument: Long-Term Evaluation of the Utility of the Pain Medication Questionnaire Cara P. Holmes, PhD; Robert J. Gatchel, PhD; Laura L. Adams, PhD; Anna W. Stowell, PhD; Alyson Hatten, MS; Carl Noe, MD; Leland Lou, MD The Eugene McDermott Center for Pain Management, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, U.S.A.  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 var- ious treatment outcomes. The PMQ was administered to 271 newly evaluated chronic pain patients who were subse- quently 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 high- est (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 develop- ment of a psychometrically sound screening tool for measur- ing 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.  Key Words: chronic pain, interdisciplinary treatment, opioid misuse, Pain Medication Questionnaire, treatment outcomes INTRODUCTION Pain represents a pervasive public health problem in the United States, affecting more than 50 million Americans and costing society more than $70 billion annually in direct healthcare costs and lost productivity. 1 Opioid medications represent an important treatment option in pain management, especially for chronic conditions that are intractable to more conservative interventions, or for which surgery is not a viable option. While opioid medications are widely considered the standard of care for treating acute and cancer pain, many physicians are reluctant to utilize opioids for chronic pain patients, citing uncertainties regarding long-term effectiveness