Interactive Interpreter

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.

For professional reference, research, and education only. Not for diagnosis or medical advice.

PMQ Score Interpreter

  • Enter a total score to see its range.

  • 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 totalInterpretation
    30+Close monitoring advisedScores 30–104. Associated with medication agreements and early refill requests; monitor closely if an opioid is prescribed.
    25–29Risk of problematic useScores 25–29. Indicative of a risk of problematic medication use; review with a clinical interview and PDMP.
    0–24Below 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.

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 [4]. Higher totals mean more risk factors; a total of 25 or more is indicative of problematic use, and 30 or more calls for close monitoring when an opioid is prescribed [1].

Why was the PMQ developed?

Chronic pain treatment often requires balancing analgesic benefit with the risks associated with prescription opioids. The PMQ was built from suspected behavioural correlates of opioid medication misuse [4] to improve early detection of people who may be at greater risk. Its item set captures 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 centres the client's own report, which can reveal attitudes and behaviours that may not appear in chart reviews. The tool supplements, rather than replaces, clinical judgment and comprehensive assessment.

What does the PMQ measure?

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. Pain itself is better measured with the Brief Pain Inventory, and broader drug use with the DAST-10.

How do you give 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).

How do you score and interpret the PMQ?

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 [1]
  • 30 or more: the client should be closely monitored when prescribed an opioid; in the predictive-validity study, scores of 30 or more were significantly associated with needing a medication agreement or requesting early refills [1]

These cut-offs come from one predictive-validity study in a single pain centre, where participants were first grouped around the sample median of 25 [1]. They apply to the original 26-item PMQ, not the shortened revised version [5].

Interpretation notes:

  • No diagnostic function; scores indicate risk, not confirmed misuse
  • Thresholds vary across populations and settings; a Brazilian adaptation in people with sickle cell anemia reported its own risk levels, with half the sample at medium risk [7]
  • 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

  • Development study. The 26-item PMQ was given to 184 adults 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 [4].
  • Long-term utility. In 271 adults, 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 [2].
  • Shortened version. A revised, shortened version kept the psychometric properties of the original and showed 85.5% predictive accuracy for medication misuse risk [5].
  • Spinal cord injury. In 122 community-dwelling adults with spinal cord injury, 44% of those who used pain medication scored 30 or more [3].
  • Systematic review. The PMQ and the SOAPP had the best evidence for predicting prescription opioid misuse [6].

Reliability

  • Moderate but acceptable reliability coefficients in the development study [4]

Validity

  • Predictive validity demonstrated for aberrant medication behaviours [1]
  • Total scores correlated moderately with problematic medication use behaviours observed by physicians [1]
  • 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 people living with chronic pain
  • 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 opioid misuse risk screeners, each with different trade-offs.

No single screener is sufficient alone. The ORT is clinician-administered and quick; the PMQ and SOAPP-R are self-report and more detailed. Combining a self-report measure with clinician assessment gives two independent views of risk.

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.

Related

FAQ

  • Is the PMQ self-report or clinician-administered?

    The PMQ is a self-report questionnaire completed by the client. This distinguishes it from clinician-administered tools such as the Opioid Risk Tool (ORT) and allows people 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 risk of medication misuse in a heterogeneous chronic pain sample. A 2017 systematic review covering 14 opioid risk tools concluded that the PMQ and the SOAPP had the best evidence for predicting prescription opioid misuse, each developed and validated in five studies, four of them of acceptable quality.

References

    1. 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.
    2. 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.
    3. 3.Mashola MK, Korkie E, Mothabeng DJ. Pain medication misuse in the South African spinal cord injury context. Health SA. 2024;29:2377.
    4. 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.
    5. 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.
    6. 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.
    7. 7.Galindo SR, da Nóbrega Marinho MH, Gatchel RJ, et al. Cross-cultural adaptation of the Pain Medication Questionnaire for use in Brazil. BMC Med Res Methodol. 2019;19(1):188.

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