Pain Medication Questionnaire (PMQ)
The PMQ (Pain Medication Questionnaire) is a 26-item self-report questionnaire that screens for risk of opioid medication misuse in adults with chronic pain, before or during long-term opioid therapy. Higher scores indicate more risk factors; it is a risk screen, not a diagnosis (Adams et al., 2004).
PMQ Score Interpreter
Scores 25–29. Indicative of a risk of problematic medication use; review with a clinical interview and PDMP.
26 self-report items; total 0–104. Higher scores indicate more risk factors for opioid medication misuse. Bands apply to the original 26-item PMQ, not the shortened revised version.
| PMQ total | Interpretation |
|---|---|
| 30+ | Close monitoring advisedScores 30–104. Associated with medication agreements and early refill requests; monitor closely if an opioid is prescribed. |
| 25–29 | Risk of problematic useScores 25–29. Indicative of a risk of problematic medication use; review with a clinical interview and PDMP. |
| 0–24 | Below the published cut-offScores 0–24. Below the cut-off of 25; a low score does not rule out misuse. |
Dowling LS et al. J Opioid Manag. 2007;3(5):257-66: a PMQ total of 25 or more is indicative of problematic use, and 30 or more suggests the patient should be closely monitored when prescribed an opioid. Range 0–104 and the 25–29 / ≥30 reading as applied in Mashola et al., Health SA. 2024;29:2377. A risk screen, not a diagnosis.
For reference only — not an assessment, diagnosis, or medical advice. This page provides scoring reference material; interpretation and clinical decisions rest with a qualified clinician.
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 behavioural 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 behaviours that may not appear in chart reviews. The tool supplements, rather than replaces, clinical judgment and comprehensive assessment.
What the PMQ measures
The PMQ evaluates behavioural 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 behaviour
- Pain-related distress and frustration
All items contribute to one summed risk score.
How to administer the PMQ
- Straightforward self-report, easy to administer in clinical settings
- Typically used before starting or continuing long-term opioid therapy
- The PMQ was developed by Adams, Gatchel and colleagues; the revised PMQ (PMQ-r) can only be used with the authors' permission. Check the copyright holder's terms before clinical or commercial use
- 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
Documenting PMQ results in clinical notes: Record the PMQ total score and risk category in the Objective section. Document the clinical response to elevated risk (e.g., enhanced monitoring plan, PDMP review date).
PMQ scoring and interpretation
Scores reflect the overall level of opioid misuse risk factors:
- Range: 0–104 (26 items)
- Higher scores → higher risk
- 25 or more: indicative of problematic use (Dowling et al., 2007)
- 30 or more: the patient should be closely monitored when prescribed an opioid; in Dowling et al. (2007), scores of 30 or more were significantly associated with needing a medication agreement or requesting early refills
These cut-offs come from one predictive-validity study in a single pain centre, where patients were first grouped around the sample median of 25. They apply to the original 26-item PMQ, not the shortened revised version (Buelow et al., 2009).
Interpretation Notes:
- No diagnostic function, scores indicate risk, not confirmed misuse
- Thresholds vary across populations and settings; a Brazilian adaptation derived its own sample-based risk levels
- Should be integrated with broader assessments, including:
- Clinical interviews
- Prescription monitoring programs
- Collateral information
- Pain/function measures
- Urine drug screening
- Elevated scores warrant closer monitoring, structured opioid agreements, or alternative pain-management planning
Psychometric properties
In the development study (Adams et al., 2004), the 26-item PMQ was given to 184 patients at an interdisciplinary pain treatment centre. Reliability coefficients were moderate but acceptable, and higher PMQ scores were associated with a history of substance abuse, higher psychosocial distress, and poorer functioning. In 271 patients, those in the highest third of PMQ scores were 2.6 times more likely to have a known substance-abuse problem, 3.2 times more likely to request early refills and 2.3 times more likely to drop out of treatment than those in the lowest third (Holmes et al., 2006). A revised, shortened version kept the psychometric properties of the original and showed 85.5% predictive accuracy for medication misuse risk (Buelow et al., 2009). A 2017 systematic review found that the PMQ and the SOAPP had the best evidence for predicting prescription opioid misuse (Lawrence et al., 2017).
Reliability
- Moderate but acceptable reliability coefficients in the development study (Adams et al., 2004)
- Stable factor structure related to psychosocial risk dimensions
Validity
- Predictive validity demonstrated for aberrant medication behaviours
- Correlates with clinician-observed risk indicators
- Good sensitivity for high-risk populations
- Not validated as a diagnostic measure for substance use disorders
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
PMQ vs ORT vs SOAPP-R
Three validated opioid misuse risk screeners, each with different trade-offs.
Recommended approach: No single screener is sufficient alone. Many pain programs use the ORT for rapid initial triage and the PMQ or SOAPP-R for detailed pre-prescribing evaluation. Using two tools with different methodologies (clinician vs self-report) reduces response bias and improves overall risk stratification accuracy.
This library is an academic and clinical reference. A scale described here is not necessarily offered in HiBoop; each page says whether it is.
Frequently Asked Questions
Is the PMQ self-report or clinician-administered?
The PMQ is a self-report questionnaire completed by the patient. This distinguishes it from clinician-administered tools such as the Opioid Risk Tool (ORT) and allows patients to disclose attitudes and behaviours they may be less willing to share directly with a prescriber. Self-report format also makes it practical for routine pre-prescribing screening in outpatient pain settings.
Can the PMQ diagnose opioid use disorder?
No. The PMQ is a risk screener, not a diagnostic tool. It identifies psychosocial factors associated with a higher likelihood of aberrant medication-related behaviours, but a diagnosis of opioid use disorder requires a structured clinical assessment using DSM-5 or ICD-11 criteria. An elevated PMQ score should prompt closer monitoring and a thorough clinical evaluation, not automatic attribution of a diagnosis.
What constructs does the PMQ measure?
The 26 items of the PMQ capture four overlapping psychosocial domains: attitudes toward medication and perceived need for opioids; social support and relational context; personal history including prior substance use and treatment adherence; and behavioural patterns such as dose self-adjustment and emotional reliance on medication. All items contribute to a single summed risk score rather than separate subscale totals.
How well does the PMQ predict aberrant drug-related behaviour?
A revised and shortened version of the PMQ demonstrated 85.5% predictive accuracy for identifying aberrant medication behaviour in a heterogeneous chronic pain sample (Buelow et al., 2009). A 2017 systematic review of 14 validated opioid risk tools concluded that the PMQ and the SOAPP had the strongest evidence base for predicting prescription opioid misuse, each validated across four or more studies of acceptable quality (Lawrence et al., 2017).
Bill this assessment
In the US, the Pain Medication Questionnaire (PMQ) is usually billed under these CPT codes. Payer rules vary.
Using this assessment in practice
For clinicians
Send it as a gentle check-in before the session. The score is waiting when you open the chart, and the trend builds itself.
For individuals
This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.
References
- 1.Dowling LS, Gatchel RJ, Adams LL, Stowell AW, Bernstein D. An evaluation of the predictive validity of the Pain Medication Questionnaire with a heterogeneous group of patients with chronic pain. J Opioid Manag. 2007;3(5):257-266.View source
- 2.Holmes CP, Gatchel RJ, Adams LL, Stowell AW, Hatten A, Noe C, Lou L. An opioid screening instrument: long-term evaluation of the utility of the Pain Medication Questionnaire. Pain Pract. 2006;6(2):74-88.View source
- 3.Mashola MK, Korkie E, Mothabeng DJ. Pain medication misuse in the South African spinal cord injury context. Health SA. 2024;29:2377.View source
- 4.Adams LL, Gatchel RJ, Robinson RC, Polatin P, Gajraj N, Deschner M, Noe C. Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. J Pain Symptom Manage. 2004;27(5):440-459.View source
- 5.Buelow AK, Haggard R, Gatchel RJ. Additional validation of the pain medication questionnaire in a heterogeneous sample of chronic pain patients. Pain Pract. 2009;9(6):428-434.View source
- 6.Lawrence R, Mogford D, Colvin L. Systematic review to determine which validated measurement tools can be used to assess risk of problematic analgesic use in patients with chronic pain. Br J Anaesth. 2017;119(6):1092-1109.View source
Last reviewed: Jun 3, 2026
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