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 were used to obtain input from a panel of pain and addiction medicine specialists to create the SOAPP questions. Download a more detailed report on the Concept Mapping process. SOAPP-R was empirically developed and validated.

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 Women's Hospital was conducted to test empirically the reliability and validity of the SOAPP v.1. Results suggest acceptable reliability (coefficient a > .73) and reasonable predictive validity. Download a brief abstract on these results. SOAPP-R was empirically developed and validated with a group of chronic pain patients from 5 pain clinics across the country. SOAPP-R is reliable and valid. Download a copy of a poster presentation that describes the development and validation process.

Q. Who should take the SOAPP?
A. The SOAPP should be given to any patient with chronic pain being considered for long-term opioid herapy.

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). SOAPP-R has a readability level just over 5th grade (Flesch-Kincaid Grade Level =5.7) 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. What is the difference between SOAPP v.1 and SOAPP-R?
A. SOAPP V.1 is available in three formats, 5, 14, and 24 items. Based on input from clinicians in the field, the team reviewed the data and developed shorter SOAPPs for clinicians who have limited time with patients. Questions in the shorter forms are original questions found in the 24-item form. Please note, the sensitivity and specificity changes as one moves from a longer to shorter SOAPP. Download a quick overview of the three tools. Download more information discussing the tradeoffs between the length and accuracy for each format. SOAPP-R is a revised version of the SOAPPv.1. It was empirically developed and contains more subtle items. SOAPP-R is a 24-item tool. Download more information about the SOAPP-R development and validation.

Q. How is SOAPP scored?
A. The SOAPP has simple scoring procedures that a clinician or clinic staff can follow. Download the scoring information.

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. Download a monitoring report on these treatment suggestions using SOAPPv.1. Monitoring recommendations are included with the SOAPP-R tool.

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, 65-75.

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.