Highlights
- •Screening tests are an important risk evaluation tool for aberrant opioid use.
- •Screeners also have the potential to be misused in clinical decision-making.
- •Proper interpretation recognizes that sensitivity does not imply predictive value.
- •The variation in base rates for aberrant opioid use complicates predictive validity.
- •With low base rates, positive results on screeners must be interpreted with caution.
Abstract
Screening tests represent a critical tool in chronic pain treatment for predicting
aberrant opioid use, which has emerged as a significant public health issue. Nevertheless,
there remains a significant potential for the misapplication of screeners in this
context. The potential difficulties in evaluating the diagnostic efficiency of screeners
have been well established, particularly with regard to the effect that the prevalence
of a disorder has on predictive value. The wide range in the reported prevalence of
aberrant opioid use behaviors makes it difficult to interpret data obtained from popular
screeners for assessing the potential for the aberrant use of opioids. Given the prevalence
of opioid problems, however, formulating clear clinical guidelines on such screeners
appears highly important. The aims of the present report include: 1) providing a review
of the salient issues necessary for interpreting diagnostic efficiency statistics
of screening tests, 2) identifying the critical differences between sensitivity, specificity,
and predictive value, and 3) discussing the characteristic effects that disease prevalence
has on statistical prediction. The article also reviews key processes in screening
measure development and highlights several key considerations relevant to their appropriate
use in clinical decision-making.
Perspective
This article highlights common metrics for evaluating the clinical utility of screening
tests in predicting aberrant opioid use. In addition, it explores a series of considerations
key to developing clinical guidelines for interpreting the results of screeners in
this context.
Key words
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Article info
Publication history
Published online: June 29, 2017
Footnotes
This work was partially supported by a grant from the National Center for Complementary and Integrative Health (R34AT008398).
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 by the American Pain Society
