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Screener and Opioid Assessment for Patients with Pain (SOAPP)

Screener and Opioid Assessment for Patients with Pain (SOAPP)
The following are some questions given to all patients at the Pain Management Center who are on or being considered for opioids for their pain. Please answer each question as honestly as possible. This information is for our records and will remain confidential. Your answers alone will not determine your treatment. Thank you.
 
  Never Seldom Sometimes Often Very often
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  1. How often do you have mood swings?
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  1. How often do you smoke a cigarette within an hour after you wake up?
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  1. How often have any of your family members, including parents and grandparents, had a problem with alcohol or drugs?
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  1. How often have any of your close friends had a problem with alcohol or drugs?
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  1. How often have others suggested that you have a drug or alcohol problem?
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  1. How often have you attended an AA or NA meeting?
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  1. How often have you taken medication other than the way that it was prescribed?
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  1. How often have you been treated for an alcohol or drug problem?
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  1. How often have your medications been lost or stolen?
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  1. How often have others expressed concern over your use of medication?
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  1. How often have you felt a craving for medication?
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  1. How often have you been asked to give a urine screen for substance abuse?
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  1. How often have you used illegal drugs (eg, marijuana, cocaine, etc) in the past five years?
[ ] [ ] [ ] [ ] [ ]
  1. How often, in your lifetime, have you had legal problems or been arrested?
[ ] [ ] [ ] [ ] [ ]
Please include any additional information you wish about the above answers.
Thank you.

 

 

 

 

 
AA: Alcoholics Anonymous; NA: Narcotics Anonymous.
* As of 2019, Inflexxion, Inc. is part of Integrative Behavioral Health, Inc.
©2016 Inflexxion, Inc. Permission granted solely for use in published format by individual practitioners in clinical practice. No other uses or alterations are authorized or permitted by copyright holder. Permissions questions: PainEDU@inflexxion.com. An online version of this tool is included in PainCAS. The SOAPP® was developed with a grant from the National Institutes of Health and an educational grant from Endo Pharmaceuticals. Reproduced with permission. Copyright © 2016 Inflexxion, Inc., Newton MA. All rights reserved. www.Inflexxion.com*.
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