Opioid Prescribing and Monitoring - (Second Edition)
Primary Care Models for Pain Management

Assessment and Monitoring of Pain: Current Tools

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Aberrant drug-taking behaviors differ in their predictive validity for opioid misuse (see Table 5).50 The Screening Tool for Addiction Risk (STAR) was developed to check for potential aberrant behaviors in patients starting long-term opioid therapy.40 The STAR is intended for use prior to initiating long-term opioid treatment and accounts for various psychosocial factors as well as other substance-related risks.40 Some questions in the original STAR version limited continuous assessment of psychosocial factors, however. Other important questions pertaining to more serious aberrant behaviors are also missing.41

Table 5. Symptoms and Predictive Behaviors Of Pain Patients With Opioid Use Disorder

Download Indiana Polyclinic STAR Evaluation (PDF)

Indiana Polyclinic STAR Evaluation

Indiana Polyclinic STAR Evaluation

Thus, with permission from the STAR developers, the Indiana Polyclinic in Indianapolis created a modified version to account for changes that may occur during long-term opioid therapy, as well as for illegal behaviors. The STAR-IPC revision includes 15 questions, is easy to score, and takes less than 5 minutes to complete (see Table 6). When used in combination with other risk management strategies, it can help clinicians highlight potential risks, recommend changes in the level of monitoring practices, or justify referrals for addiction treatment or ceasing opioids altogether.

The STAR-IPC version has several limitations: It is not intended to be a lie-
detector test and should not be used without additional monitoring strategies such as drug screens, communication with other providers and the patient’s relatives, inspection of medical records, and drug monitoring programs. The revised version has not been validated and requires additional studies. It may be further improved by adding a question about the use of benzodiazepines.


Although each pain assessment tool has strengths and weaknesses, recent additions and updates may offer health care professionals more help in ensuring the proper management of chronic pain without needlessly contributing to the risk of long-term opioid misuse by their patients.

Acknowledgements: The authors wish to thank Jo Ann LeQuang and Scott de Long, who helped with editing and proofreading this manuscript.

Last updated on: September 13, 2017
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