What is the PMQ?

The Pain Medication Questionnaire (PMQ) is a self-report screening tool developed by Adams et al. (2004) to identify patients who may be at risk for opioid misuse or substance abuse while already undergoing opioid therapy. Unlike tools used in pre-treatment screening, the PMQ is specifically designed for use during treatment to support clinical decision-making and identify individuals who may benefit from closer monitoring or intervention.

The PMQ is included in the Creyos Health platform alongside cognitive assessments and other behavioral health questionnaires, offering a multifaceted view of patient risk and well-being.

Use in Clinical Settings

The PMQ helps clinicians assess how patients feel about their pain and medication use over time. It is applicable across various care settings, including pain management clinics, behavioral health practices, and primary care environments treating chronic pain.

Importantly, while the PMQ was originally developed around opioid use, it is intentionally non-specific in its language, making it appropriate for use in evaluating a broad range of pain medications and potential substance misuse.

How It Works

The questionnaire includes 26 items, each answered using a 5-point Likert scale ranging from “never” to “always” or “disagree” to “agree.” Responses are scored and totaled to yield a risk classification:

• 0–15 points: Low risk

• 16–24 points: Moderate risk

• 25–104 points: High risk

Higher scores suggest a greater likelihood of aberrant drug-related behaviors. In one validation study (Holmes et al., 2006), patients scoring in the highest third were significantly more likely to exhibit signs of substance misuse, drop out of treatment, or request early refills, supporting the tool’s utility in clinical decision-making.

How It Relates to Cognition

Cognition and substance use are closely linked. Opioid medications can impair attention, working memory, and executive function—particularly with chronic use. Conversely, pre-existing cognitive deficits may increase the risk of substance misuse, making cognitive monitoring an important part of treatment planning (Melugin et al., 2021).

Research shows that even therapeutic use of opioids can impair short-term cognition (Cherrier et al., 2009) and lead to long-term cognitive changes with continued use (Warner et al., 2022). Additionally, chronic pain itself can contribute to deficits in memory and attention, especially when comorbid with mental health conditions like depression (McCracken & Iverson, 2001).

By combining the PMQ with Creyos Health cognitive tasks, clinicians gain insight into how both pain and its treatment may be affecting cognitive functioning—supporting more informed, comprehensive care.

Psychometric Properties

The PMQ has demonstrated strong reliability and predictive validity in identifying risk for opioid misuse. It remains a widely used instrument in both clinical research and real-world care settings.

Clinical Considerations

The PMQ is a screening tool, not a diagnostic instrument. Scores should be used in conjunction with clinical interviews, history taking, and other assessments (such as the AUDIT, DAST-10, or ORT) to evaluate overall risk and determine next steps in care. Clinical judgment is essential when interpreting results and formulating treatment plans.

To explore all behavioral and cognitive health tools available in the Creyos platform, refer to the Creyos Standardized Questionnaires Guide.