Assessing risk of opioid misuse in the treatment of chronic pain: Building a practical actuarial approach

Opioid misuse risk assessment has been highlighted as an important part of clinical practice, but there is a paucity of research identifying an effective approach to assessment. Currently, practitioners use patient history, interviews, and formal questionnaires, and these data are weighed clinically to assign risk. The authors propose the use of an actuarial method-the Bayesian nomogram-as a simple, standard, evidence-based approach to opioid misuse risk assessment.The Bayesian nomogram relies solely on empirically established relationships between risk factors and risk and has been found in other fields to be both more efficient and more consistent than clinical judgment. The authors performed a comprehensive search of the literature to identify empirically established risk factors for opioid misuse in the treatment of noncancer chronic pain.As the Bayesian nomogram requires both base rates of the predicted event (opioid misuse) and odds ratios for risk factors, the authors reported the most current evidence available in the literature. The authors also included the nomogram itself for easy clinical application of base rates and risk factors in the predictive model. Finally, the authors provided examples to help illustrate practical application.The authors call for research comparing this methodology to "assessment as usual" to better predict risk of opioid misuse and to aid decision making for medical providers treating chronic-pain patients.