7. True or false? The Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients With Pain–Revised (SOAPP-R) are useful instruments for predicting the likelihood that opioid use disorder will develop in patients with no identified risk factors who take opioid analgesics prescribed for legitimate pain complaints.
Discussion: Both ORT and SOAPP-R self-identify past and current history that indicates substance abuse, but neither has been found to have any predictive value for substance use disorder.
Answer: B. False
8. Which class of medications is contraindicated in patients with chronic pain who are taking opioid analgesics?
B. Tricyclic antidepressants
D. All of the above
Discussion: Use of a benzodiazepine with an opioid analgesic significantly increases the risk of death from overdose. Furthermore, extended use of a benzodiazepine can cause hyperalgesia.2 There is evidence that taking a tricyclic antidepressant with an opioid analgesic may actually have a beneficial synergistic effect.4
Answer: C. Benzodiazepines
1. Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016;374:154-163.
2. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain: United States, 2016. MMWR. 2016;65:1-150.
3. Sullivan MD, Ballantyne JC. Must we reduce pain intensity to treat chronic pain? Pain. 2016;157:65-69.
4. Gilron I, Tu D, Holden RR, et al. Combination of morphine with nortriptyline for neuropathic pain. Pain. 2015;156:1440-1448.
5. Smith TJ, Saiki CB. Cancer pain management. Mayo Clin Proc. 2015;90:1428-1439.