Does the perceived accuracy of urine drug testing impact clinical decision-making?

Urine drug testing techniques have different rates of false-positive and false-negative test results. However, clinicians may have highly varying perceptions of test accuracy and may compensate for perceived inaccuracy by incorporating other factors into their interpretation of observed test results. Thus, there is the potential for adverse consequences from decisions based on inaccurate test results or interpretation.

Sleep problems in breast cancer survivors 1-10 years posttreatment.

Unlabelled: ABSTRACTObjective:Sleep can affect quality of life (QoL) during cancer survivorship, and symptoms related to poor sleep can be exacerbated. We examined the prevalence, severity, and nature of subjective sleep complaints in women surviving stage I-III breast cancer who were 1-10 years posttreatment. We also examined the demographic, medical, physical, and psychosocial correlates of poor sleep in these women in order to identify the subgroups that may be most in need of intervention.

Definitive LC-MS/MS Drug Monitoring Impacts Substance-use Treatment Planning and Patient Outcomes: A Brief Report.

Clinical drug monitoring has an increasingly important role in the treatment of substance use disorders. Through semistructured interviews, we asked substance-use counselors about the clinical impact of drug tests on patients' treatment planning and outcomes. This study was conducted around the time of a facility-wide switch to a laboratory utilizing definitive liquid chromatography with tandem mass spectrometry from a laboratory that had utilized the less-sensitive, presumptive immunoassay-based drug-testing methodology.

An Online Survey of Patients' Experiences Since the Rescheduling of Hydrocodone: The First 100 Days.

Objective: To conduct an Internet patient survey through the National Fibromyalgia & Chronic Pain Association on reactions to the first 100 days following the rescheduling of hydrocodone.

Methods: Face-valid survey questions were created with expert consensus along with repurposed questions used on previous NFMCPA surveys covering domains such as demographics and symptoms. The questionnaire was designed to be administered over the Internet.

Counselors' Clinical Use of Definitive Drug Testing Results in Their Work with Substance-Use Clients: a Qualitative Study.

We conducted a psychotherapeutic examination of the use of definitive drug testing (liquid chromatography with tandem mass spectrometry) in the treatment of substance use disorders (SUD). Employing a generic qualitative method (Caelli et al. in (2), 2003; Merriam, 2009) we asked SUD counselors to provide narratives about cases where drug testing had revealed new or unexpected information about clients' drug-taking behaviors.

A Survey of ASAM Members' Knowledge, Attitudes, and Practices in Urine Drug Testing.

Objectives: Urine drug testing (UDT) can play an important role in addiction medicine. Indeed, the American Society of Addiction Medicine (ASAM) recently released a white paper, detailing the history of UDT, emphasizing recent advances in the laboratory and clinical science of UDT, and discussed the potential for broadening clinical utility of UDT. We conducted a survey of ASAM members to better understand their knowledge, attitudes, and practices with regard to UDT.

The complexity model: a novel approach to improve chronic pain care.

Objective: More than 25% of the US population experiences chronic pain; yet few physicians specialize in the field of pain medicine. This article will review a theoretical model of care that stratifies treatment and patients by level and type of complexity and promotes communication between specialist and primary care providers.

Discussion: The undertreatment of pain was recently brought to national attention to encourage both clinicians and patients to advocate for improved pain care.

FDA/DEA/PDMP/UDT: alphabet soup or sensible and integrated risk management?

Objective: Both prescription drug monitoring programs (PDMP) and urine drug testing (UDT) are recommended as parts of an ongoing risk management approach for controlled substance prescribing. The authors provide an editorial and commentary to discuss the unique contributions of each to promote better clinical decision making for prescribers.

Design: A commentary is employed along with brief discussion comparing four states with an active PDMP in place to three states without an active PDMP as it relates back to findings on UDT in those states from a laboratory conducting liquid chromatography tandem mass spectrometry.

Trends in drug use from urine drug testing of addiction treatment clients.

Objective: Urine drug testing (UDT) can play an important role in the care of patients in recovery from addiction, and it has become necessary for providers and programs to utilize specific, accurate testing beyond what immunoassay (IA) provides.

Design: A database of addiction treatment and recovery programs was sampled to demonstrate national trends in drug abuse and to explore potential clinical implications of differing results due to the type of testing utilized.

Setting: Deidentified data was selected from a national laboratory testing company that had undergone liquid chromatography tandem mass spectrometry (LC-MS/MS).

Specimen validity testing in urine drug monitoring of medications and illicit drugs: clinical implications.

Objective: To discuss the importance of specimen validity testing (SVT) in urine drug testing (UDT) and the clinical role it plays in identifying efforts to subvert the UDT process.

Methods: A discussion of the clinical impact of SVT is presented.

Results: A discussion of pH, specific gravity, creatinine, and oxidation for monitoring the adulteration of UDT samples is presented along with the clinical significance of such tests.

A primer on definitive gas and liquid chromatography drug testing: What clinicians need to know.

Objective: To describe the differences between mass spectrometry technologies and compare and contrast them with immunoassay techniques of urine drug testing (UDT). Highlight the potential importance of the differences among these technologies for clinicians so as to allow them make decisions in their use in patient care.

Methods: Review of mass spectrometry techniques, including gas chromatography, liquid chromatography, and time-of-flight techniques.

Clinicians' perspective on the use of immunoassay versus definitive laboratory quantitation methodologies for medication monitoring.

Treating chronic pain is complicated. Primary care doctors and others are called on to treat the vast majority of patients with pain, to do so in brief visits and to do it safely. This is a tall order, but it is possible to do it well when the proper tools are employed to aid the clinician in diagnosing and monitoring the patient.

Exploring rates of abnormal pharmacogenetic findings in a pain practice.

Pharmacogenetic testing (PGT) is part of increasing efforts to personalize medicine, hopefully leading to better medication selection with more effective, less toxic therapies. Pharmacogenetic testing has relevance for chronic pain treatment, given the frequent comorbidities and polypharmacy. This retrospective study explored the prevalence of polymorphisms in a specialty pain practice in Louisiana.

Frequency, characteristics, and correlates of pain in a pilot study of colorectal cancer survivors 1-10 years post-treatment.

Objective: The long-term effects of disease and treatment in colorectal cancer (CRC) survivors are poorly understood. This study examined the prevalence and characteristics of pain in a sample of CRC survivors up to 10 years post-treatment.

Design: One hundred cancer-free CRC survivors were randomly chosen from an institutional database and completed a telephone survey using the Brief Pain Inventory, Neuropathic Pain Questionnaire-Short Form, Quality of Life Cancer Survivor Summary, Brief Zung Self-Rating Depression Scale, Zung Self-Rating Anxiety Scale, and Fear of Recurrence Questionnaire.

The chronic pain patient and functional assessment: use of the 6-Minute Walk Test in a multidisciplinary pain clinic.

Objective: For chronic pain treatment, guidelines and regulatory agencies have defined functional improvement as a primary goal, especially when chronic opioid therapy is used. Functional improvement is frequently evaluated by qualitative questioning. This pilot study sought to establish a simple and inexpensive measure of functional change for a chronic pain population.

Characterization of prescription opioid abuse in the United States: focus on route of administration.

Prescription opioids are prescribed increasingly for the management of chronic pain, and this has been accompanied by a dramatic rise in opioid-related abuse, addiction, and overdose deaths. Reports of abuse involving nonoral administration (e.g.

Development and implementation of a palliative care consultation tool.

Objective: Palliative care services are becoming more commonplace in hospitals and have the potential to reduce hospital costs through length of stay reduction and remediation of symptoms. However, there has been little systematic attempt to identify when a palliative care consultation should be triggered in a hospital, and there is some evidence that these services are under-utilized and not fully understood.

Method: In an initial attempt to address when a consultation might be appropriate, we attempted to pilot test a novel palliative care screening tool to help guide clinician judgment in this regard.

Issues and critiques of the forthcoming risk evaluation and mitigation strategy (REMS) for opioids in pain management.

Objective: To examine the history and suitability of the Food and Drug Administration's (FDA) Risk Evaluation and Mitigation Strategy (REMS) for reducing the safety risks associated with the use of opioid medications, including the risks of abuse and overdose. This article will highlight recent attempts by the FDA to introduce a class wide REMS for new and existing Schedule II long-acting opioid drugs. A critique of these current REMS efforts and recommendations for the future will also be provided.

Ethical considerations in urine drug testing.

Recent passage of a House Bill in the state of Washington led to a commentary on whether mandates for urine drug testing of pain patients represented a breach of the Fourth and Fourteenth Amendment rights of patients. Issues over true consent to such tests and potential view of warrantless searches were discussed. The authors address these concerns in a broader context of risk management and stratification efforts, along with discussion about the need for a tailored approach in this arena and consideration of cost burden for such tests.

Pseudoaddiction revisited: a commentary on clinical and historical considerations.

SUMMARY The term 'pseudoaddiction' has been in the pain management lexicon for two decades. Over this time, pain management has changed significantly - in no small part as a result of a landmark publication by Weissman and Haddox in 1989. The original paper, which describes the experience of a single case study in which a young inpatient with cancer became sullen and difficult when left in uncontrolled pain, is reviewed.

Multimodal approaches to optimize outcomes of chronic opioid therapy in the management of chronic pain.

Objective: To review clinical strategies for long-term opioid management as well as strategies to assess and monitor patients with moderate to severe chronic pain who may be at risk for aberrant drug-related behaviors.

Design: A symposium was held to disseminate a review of opioid use strategies, including use of the Universal Precautions in Pain Medicine as well as the Federation of State Medical Boards Model Policy for Prescribing Controlled Substances (FSMB model policy). These include continual reassessment of pain and risk, treatment agreements, compliance monitoring, urine drug screening, documentation, compliance with the law, and patient education.

Addictions in pain clinics and pain treatment.

A great deal of fear exists in the world of pain management on the part of both healthcare professionals and some patients where issues of abuse, misuse, and addiction are concerned. While it might be easy to consider all pain patients as "drug seekers" or addicts, the reality remains that most pain patients are genuine; we therefore must retain pain management efforts for the many, while being aware and cognizant of the few who have problems such as addiction. To begin to separate these entities, definitions and hallmarks of addiction are explored along with discussion of screening tools that can be employed to help identify problematic patients.

Defining clinical issues around tolerance, hyperalgesia, and addiction: a quantitative and qualitative outcome study of long-term opioid dosing in a chronic pain practice.

Treatment with opioid medications has grown over the past decades, but has been surrounded by some ongoing controversy and debate to whether it is causing more harm than good for patients. To this end, the field of pain management has suffered from a lack of clarity about some basic definitions on concepts such as tolerance and hyperalgesia. Some characterize these issues as inevitable parts of opioid therapy while other schools of thought look at these issues as relatively rare occurrences.

Assessing self-efficacy for coping with cancer: development and psychometric analysis of the brief version of the Cancer Behavior Inventory (CBI-B).

Objective: The Cancer Behavior Inventory-Brief Version (CBI-B), a 12-item measure of self-efficacy for coping with cancer derived from the longer 33-item version, was subjected to psychometric analysis.

Method: Participants consisted of three samples: 735 cancer patients from a multicenter CCOP study, 199 from central Indiana, and 370 from a national sample. Samples were mixed with respect to initial cancer diagnosis.