Pain Medication Questionnaire (PMQ)
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The Pain Medication Questionnaire (PMQ) is a 26-item self-report screening tool designed to identify risk factors for opioid misuse, medication-related behavioural concerns, and problematic adherence patterns in adults with chronic pain. Developed by Adams, Gatchel, and colleagues, the PMQ assesses attitudes, beliefs, behaviors, and psychosocial factors linked to increased risk for aberrant opioid use.
The PMQ produces a single total score (range 26–130), with higher scores indicating greater risk. Although commonly used in pain clinics and pre-prescribing contexts, the PMQ is a screening instrument, not a diagnostic tool, and should be interpreted in combination with clinical interviews, prescription monitoring, and broader risk assessments.
Type: Opioid misuse risk screener
Population: Adults using prescribed opioid analgesics
Length: 26 items
Format: Self-report
Completion Time: 5–7 minutes
Use this measure at the start of opioid therapy, before unclear dose escalations, and at least annually—or more often if concerns arise—while noting it isn’t meant for high-frequency monitoring.
Foundational Context
Chronic pain treatment often requires balancing analgesic benefit with the risks associated with prescription opioids. The PMQ was created to improve early detection of patients who may be at greater risk for medication misuse. Its item set captures known psychosocial correlates of opioid-related risk, including:
- Preoccupation with medication
- Past substance misuse
- Pain-related distress
- Inconsistent adherence
- Emotional or behavioral responses to opioid use
Unlike some risk tools based solely on clinician ratings or historical factors, the PMQ centers patient self-report to reveal attitudes and behaviors that may not appear in chart reviews. The tool supplements—rather than replaces—clinical judgment and comprehensive assessment.
What the Assessment Measures
The PMQ evaluates behavioral and psychological factors associated with opioid misuse risk:
- Concerns about access to medication
- Worry over inadequate dosing
- Tendency to self-adjust doses
- Using medication to cope emotionally
- History of substance use
- Inconsistent or maladaptive adherence behavior
- Pain-related distress and frustration
All items contribute to one summed risk score.
Interpretation Guidelines
Scores reflect the overall level of opioid misuse risk factors:
- Range: 26–130
- Higher scores → higher risk
- Common research-supported threshold:
- ≥30–33 associated with elevated risk for aberrant medication-related behaviors
Interpretation Notes:
- No diagnostic function—scores indicate risk, not confirmed misuse
- Thresholds vary across populations and settings
- Should be integrated with broader assessments, including:
- Clinical interviews
- Prescription monitoring programs
- Collateral information
- Pain/function measures
- Elevated scores warrant closer monitoring, structured opioid agreements, or alternative pain-management planning
Psychometric Properties
Reliability
- Good internal consistency across the 26 items
- Stable factor structure related to psychosocial risk dimensions
Validity
- Predictive validity demonstrated for aberrant medication behaviors
- Correlates with clinician-observed risk indicators
- Good sensitivity for high-risk populations
- Not validated as a diagnostic measure for substance use disorders
Administration Considerations
- Straightforward self-report, easy to administer in clinical settings
- Must be interpreted within a harm-reduction and non-stigmatizing framework
- Elevated scores do not imply noncompliance or wrongdoing—risk factors are multifactorial
- Should not influence prescribing decisions without corroborating assessment
- Useful as part of multidisciplinary pain management
Limitations
- Risk assessment only—does not detect actual misuse
- Self-report may be influenced by stigma or fear of medication restriction
- Some items overlap with legitimate concerns of chronic pain patients
- Cultural and contextual factors may influence responses
- Should not be used in isolation to deny treatment or determine culpability
Copyright
© Adams, Gatchel, Robinson, Polatin, & Gajraj (2004). All rights reserved.
References
- Adams, L. L., Gatchel, R. J., Robinson, R. C., Polatin, P. B., & Gajraj, N. (2004). Development of the PMQ. Journal of Pain and Symptom Management, 27(5), 440–459. https://doi.org/10.1016/j.jpainsymman.2003.09.006
- Gatchel, R. J., et al. (2005). PMQ psychometric evaluations. Pain. https://pubmed.ncbi.nlm.nih.gov/15818816/
Disclaimer
This article is for educational purposes only and not a substitute for clinical judgment or medical evaluation. The PMQ is a screening tool and should be interpreted within a comprehensive pain and risk assessment process.
Permissions
The PMQ is the intellectual property of its original authors and publishers. Use in clinical or research settings requires appropriate citation, and reproduction of the full questionnaire may require permission from the rights holders.
Frequently Asked Questions
Does a high PMQ score mean a patient is misusing opioids?
No. It reflects risk factors, not misuse itself.
Should the PMQ be repeated often?
Annually or as clinically indicated; not designed for high-frequency use.
Can the PMQ diagnose opioid use disorder?
No. Diagnostic evaluation requires structured clinical assessment.
Is the PMQ appropriate for acute pain patients?
It is primarily validated for chronic pain contexts.
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