The World Health Organization Disability Assessment Schedule-2.0 (WHODAS 2.0) in a chronic pain population being considered for chronic opioid therapy

Abstract

Kelly M Wawrzyniak,1,2 Matthew Finkelman,3 Michael E Schatman,1,4 Ronald J Kulich,1,2 Valerie F Weed,5 Eura Myrta,1 David J DiBenedetto1,21Boston PainCare Center, Waltham, MA 02451, USA; 2Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA 02111, USA; 3Division of Biostatistics and Experimental Design, Tufts University School of Dental Medicine, Boston, MA 02111, USA; 4Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA; 5Primary Care Psychology Associates, LLC, Northbrook, IL 60062, USAPurpose: To examine the validity of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for the assessment of function in a community-based sample of patients with chronic pain conditions undergoing evaluation for chronic opioid therapy. Patients and methods: One hundred nine of 124 patients were evaluated for a chronic opioid therapy program between December 1, 2014 and April 10, 2015, inclusive, at one community-based interdisciplinary pain management practice. Measures included: demographic data; the WHODAS 2.0; a modified version of the Roland Morris Disability Questionnaire (RMDQ-m); the Patient Health Questionnaire-9 item (PHQ-9); the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R); the Current Opioid Misuse Measure (COMM), the Opioid Risk Tool (ORT); opioid dose. These data were collected as part of routine care, and this retrospective chart review study examined the data from this convenience sample, comparing the results of each assessment tool to the results of the WHODAS 2.0. Results: Median score on the WHODAS 2.0 was 25.69 (IQR=16.01 to 35.28). WHODAS 2.0 score was significantly correlated with the RMDQ-m (rs=0.69, p<0.001), the PHQ-9 (rs=0.68, p<0.001), the COMM (rs=0.52, p<0.001) and the SOAPP-R (rs=0.51, p<0.001). There was no significant correlation between the WHODAS 2.0 and the ORT (rs=0.14, p=0.12) or opioid dose (rs=0.07, p=0.47)Conclusions: The WHODAS 2.0 was significantly positively correlated with other measures, including measures of disability, risk of opioid misuse, and depression among patients being evaluated for chronic opioid therapy. The WHODAS 2.0 may be a useful measure of disability across a number of important domains when discussing expectations of both patients and providers at initiation of opioid therapy for chronic pain management. This assessment and discussion is crucial, particularly given the focus on function, rather than analgesia alone, when evaluating the effectiveness of opioid treatment.Keywords: disability, chronic pain, opioids, function

Keywords

• disability
• chronic pain
• opioids
• function