SOAPP: Screener and Opioid Assessment for Patients with Pain
SOAPP is a tool developed and copyrighted by Inflexxion and is presented here for educational purposes
and clinical purposes. The tool represents an assessment of risk of prescription opiate abuse by a chronic
pain patient. It appears to be a reasonable risk assessment tool even though it was funded by Endo
Pharmaceutical company which has a vested interest in selling narcotics. While the conclusion "Making
effective long-term opioid therapy available to this large group of patients could represent a major public health
advance" is a veiled sales pitch for narcotics manufacturers and the conclusion "Even patients with a history of
substance abuse deserve to have their pain treated" is quite controversial in a population that could well kill
themselves or others by abusing opiates, the other aspects of the questions and answers below are
balanced, reasonable approaches to opiate prescribing. Normally, I find narcotic manufacturer paid forms to
be officious, but this form may actually be useful as well as the organization :
SCORING SOAPP: Only some of the test questions are predictive of potential
substance abuse within 6 months.
Score the questions 2, 7, 10, 11, 12, 13, 15, 17, 18, 19, 20, 22, 23, 24
If the sum of the score is 7 or higher, then there is a 91% chance of substance
abuse in those who are actually high risk. However, 30% of those at low risk will have a score 7 or higher.
Therefore the false negative rate is 9% and the false positive rate is 30%.
Click here to download a pdf file of the SOAPP questionnaire.
Questions
Q.How was the SOAPP developed?
A. The SOAPP was developed based on expert consensus regarding important concepts likely to predict which patients will require
more or less monitoring on long-term opioid therapy (content and face valid). Concept Mapping procedures to obtain input from a panel
of pain and addiction medicine specialists to create the SOAPP questions.
Q.What kind of data are available on the reliability and validity of the SOAPP?
A. Ongoing data collection at the Pain Management Center of Brigham and Womens’ Hospital is being conducted to test empirically the reliability and
validity of the SOAPP. Preliminary results suggest acceptable reliability (coefficient a > .73) and reasonable predictive validity. Download a brief abstract
on these results.
Q.Who should take the SOAPP?
A. The SOAPP should be given to any patient with chronic pain being considered for long-term opioid therapy.
Q.How should the tool be administered?
A. A patient can complete the questionnaire in the waiting room, examination room, or prior to the health visit. The SOAPP version 1.0 has a readability
level of just over the 4th grade (Flesch-Kincaid Grade Level = 4.2). Physicians, physician assistants, nurses, or office staff can administer the tool
during the health visit. Most patients should be able to complete the questionnaire unaided.
Q.Does the SOAPP screen patients out for consideration of opioid regimen?
A. The SOAPP is NOT intended to rule out/screen out chronic pain patients for opioid therapy. Information from the SOAPP should be considered along
with other clinical findings to determine an appropriate treatment plan. The SOAPP should NEVER be used to deny treatment of any patient’s pain. All
patients in pain should have that pain treated (American Academy of Pain Medicine, 1997; Jamison, 2002).
Q.What about individuals with a history of substance abuse?
A. Even patients with a history of substance abuse deserve to have their pain treated. Weaver and Schnoll (2002) note that undertreatment of pain in
patients with addiction histories is more likely than adequate treatment to lead to drug-seeking behavior in recovering addicts. Such individuals may
require a greater level of monitoring; however, a substance abuse history alone should not deny patients access to opioid therapy.
Q.How is SOAPP scored?
A. The SOAPP has simple scoring procedures that a clinician or clinic staff can follow.
Q.Does a "high" risk score indicate that the patient should not be prescribed opioids?
A. The SOAPP is NOT intended to rule out/screen out chronic pain patients for opioid therapy. The SOAPP data, along with other clinical findings, can
help the provider determine the level of monitoring that may be necessary to safely prescribe long-term opioid therapy for a given patient. Each provider
will have a different level of comfort and/or resources dealing with higher risk patients. High-risk patients may require smaller prescriptions, more
frequent visits, referral to a specialist, or other intervention. Download monitoring recommendations developed by pain treatment experts.
Q.Does a “low” risk score indicate that the patient does not need to be closely monitored?
A. As with higher scores, lower scores on the SOAPP should always be considered in the context of the entire clinical findings. Other factors such as
how well the patient is known to the provider, the stability of the patients’ family life and functioning history, should be considered. It is estimated that
between 3% to 16% of chronic pain patients develop problematic addictive behaviors. While some argue that this estimate may be low
(Kirsch et al., 2002), most experts agree that MOST chronic pain patients (estimate range from 50%-80%) do not develop aberrant
medication problems. Making effective long-term opioid therapy available to this large group of patients could represent a major public health
advance.
Q.How should clinicians interpret the SOAPP scores?
A. The SOAPP tool is designed to assist clinicians who are determining a treatment plan for a patient with chronic pain. The SOAPP is not meant to be
the only decision-making tool used during this process. Clinicians should always base treatment decisions on clinical observations, information from the
patient's medical records, family report, and other clinical data along with SOAPP results. When possible, consultation with a pain expert will enhance
any pain treatment plan. Pain management experts have generated some treatment suggestions to guide clinicians whose patients score in the different
risk categories of the SOAPP.
References:
Butler, S.F., Budman, S.H., Fernandez, K., & Jamison, R.N. (2004). Validation of a screener and opioid assessment measure for patients with chronic
pain. Pain, 112, 65&150;75.
Kirsch, K.L., Whitcomb, L.A., Donaghy, K., & Passick, S.D. (2002). Abuse and addiction issues in medically ill patients with pain: Attempts at clarification
of terms and empirical study. The Clinical Journal of Pain, 18, S52-S60.
and clinical purposes. The tool represents an assessment of risk of prescription opiate abuse by a chronic
pain patient. It appears to be a reasonable risk assessment tool even though it was funded by Endo
Pharmaceutical company which has a vested interest in selling narcotics. While the conclusion "Making
effective long-term opioid therapy available to this large group of patients could represent a major public health
advance" is a veiled sales pitch for narcotics manufacturers and the conclusion "Even patients with a history of
substance abuse deserve to have their pain treated" is quite controversial in a population that could well kill
themselves or others by abusing opiates, the other aspects of the questions and answers below are
balanced, reasonable approaches to opiate prescribing. Normally, I find narcotic manufacturer paid forms to
be officious, but this form may actually be useful as well as the organization :
SCORING SOAPP: Only some of the test questions are predictive of potential
substance abuse within 6 months.
Score the questions 2, 7, 10, 11, 12, 13, 15, 17, 18, 19, 20, 22, 23, 24
If the sum of the score is 7 or higher, then there is a 91% chance of substance
abuse in those who are actually high risk. However, 30% of those at low risk will have a score 7 or higher.
Therefore the false negative rate is 9% and the false positive rate is 30%.
Click here to download a pdf file of the SOAPP questionnaire.
Questions
Q.How was the SOAPP developed?
A. The SOAPP was developed based on expert consensus regarding important concepts likely to predict which patients will require
more or less monitoring on long-term opioid therapy (content and face valid). Concept Mapping procedures to obtain input from a panel
of pain and addiction medicine specialists to create the SOAPP questions.
Q.What kind of data are available on the reliability and validity of the SOAPP?
A. Ongoing data collection at the Pain Management Center of Brigham and Womens’ Hospital is being conducted to test empirically the reliability and
validity of the SOAPP. Preliminary results suggest acceptable reliability (coefficient a > .73) and reasonable predictive validity. Download a brief abstract
on these results.
Q.Who should take the SOAPP?
A. The SOAPP should be given to any patient with chronic pain being considered for long-term opioid therapy.
Q.How should the tool be administered?
A. A patient can complete the questionnaire in the waiting room, examination room, or prior to the health visit. The SOAPP version 1.0 has a readability
level of just over the 4th grade (Flesch-Kincaid Grade Level = 4.2). Physicians, physician assistants, nurses, or office staff can administer the tool
during the health visit. Most patients should be able to complete the questionnaire unaided.
Q.Does the SOAPP screen patients out for consideration of opioid regimen?
A. The SOAPP is NOT intended to rule out/screen out chronic pain patients for opioid therapy. Information from the SOAPP should be considered along
with other clinical findings to determine an appropriate treatment plan. The SOAPP should NEVER be used to deny treatment of any patient’s pain. All
patients in pain should have that pain treated (American Academy of Pain Medicine, 1997; Jamison, 2002).
Q.What about individuals with a history of substance abuse?
A. Even patients with a history of substance abuse deserve to have their pain treated. Weaver and Schnoll (2002) note that undertreatment of pain in
patients with addiction histories is more likely than adequate treatment to lead to drug-seeking behavior in recovering addicts. Such individuals may
require a greater level of monitoring; however, a substance abuse history alone should not deny patients access to opioid therapy.
Q.How is SOAPP scored?
A. The SOAPP has simple scoring procedures that a clinician or clinic staff can follow.
Q.Does a "high" risk score indicate that the patient should not be prescribed opioids?
A. The SOAPP is NOT intended to rule out/screen out chronic pain patients for opioid therapy. The SOAPP data, along with other clinical findings, can
help the provider determine the level of monitoring that may be necessary to safely prescribe long-term opioid therapy for a given patient. Each provider
will have a different level of comfort and/or resources dealing with higher risk patients. High-risk patients may require smaller prescriptions, more
frequent visits, referral to a specialist, or other intervention. Download monitoring recommendations developed by pain treatment experts.
Q.Does a “low” risk score indicate that the patient does not need to be closely monitored?
A. As with higher scores, lower scores on the SOAPP should always be considered in the context of the entire clinical findings. Other factors such as
how well the patient is known to the provider, the stability of the patients’ family life and functioning history, should be considered. It is estimated that
between 3% to 16% of chronic pain patients develop problematic addictive behaviors. While some argue that this estimate may be low
(Kirsch et al., 2002), most experts agree that MOST chronic pain patients (estimate range from 50%-80%) do not develop aberrant
medication problems. Making effective long-term opioid therapy available to this large group of patients could represent a major public health
advance.
Q.How should clinicians interpret the SOAPP scores?
A. The SOAPP tool is designed to assist clinicians who are determining a treatment plan for a patient with chronic pain. The SOAPP is not meant to be
the only decision-making tool used during this process. Clinicians should always base treatment decisions on clinical observations, information from the
patient's medical records, family report, and other clinical data along with SOAPP results. When possible, consultation with a pain expert will enhance
any pain treatment plan. Pain management experts have generated some treatment suggestions to guide clinicians whose patients score in the different
risk categories of the SOAPP.
References:
Butler, S.F., Budman, S.H., Fernandez, K., & Jamison, R.N. (2004). Validation of a screener and opioid assessment measure for patients with chronic
pain. Pain, 112, 65&150;75.
Kirsch, K.L., Whitcomb, L.A., Donaghy, K., & Passick, S.D. (2002). Abuse and addiction issues in medically ill patients with pain: Attempts at clarification
of terms and empirical study. The Clinical Journal of Pain, 18, S52-S60.
