Cramer G W, Galer B S, Mendelson M A, Thompson G D
Kaiser Permanente, Atlanta, Georgia, USA.
J Am Geriatr Soc. 2000 Apr;48(4):398-404. doi: 10.1111/j.1532-5415.2000.tb04697.x.
To determine the medical conditions for which selected analgesics are most frequently prescribed in nursing facilities (NFs), describe the use of pharmacologic and nonpharmacologic pain therapies, and determine the frequency and quality of pain assessment in NF residents.
A multicenter, 3-month retrospective drug use evaluation conducted by consultant pharmacists.
Eighty-nine NFs having no more than 25% of their patient census representing special populations (e.g., head trauma).
A total of 2065 adult NF residents who received at least one selected analgesic.
Primary indication for analgesics, pain type, method of pain assessment, nonpharmacologic therapies for pain, prescribed analgesics and regimens, and comorbid conditions were recorded.
A total of 54.3% of residents had one indication for analgesic therapy, 31.0% had two indications, and 14.7% had three or more indications. Arthritis was the most prevalent indication for analgesics (41.7% of residents), followed by bone fracture (12.4%) and other musculoskeletal conditions (9.7%). More residents (76.8%) were reported to have chronic pain than acute pain (19.9%), and 3.0% had both chronic and acute pain. Pain type was unknown for 0.2% of residents. Observational pain assessments were used more frequently (for 55.9% of residents) than objective methods (16.6%), and pain was not assessed in 40.6% of residents. Most residents (69.4%) received no nonpharmacologic treatment for pain. Of the 2542 opioid and nonsteroidal anti-inflammatory drug (NSAID) prescriptions, 67.6% were for opioids, 24.8% were for NSAIDs, and 7.6% were for tramadol. Propoxyphene-containing drugs were the most frequently prescribed opioid group, and propoxyphene with acetaminophen was the most frequently prescribed analgesic (35.6% of all analgesics). Most analgesics (63.2%) were prescribed on an as-needed (prn) basis.
The findings show a lack of adequate pain assessments, little use of nonpharmacologic interventions, and inappropriate use of analgesic medication. The small percentage of residents with chronic pain assessed objectively suggests the difficulty of monitoring pain progression in NFs. The prescribing of analgesic for most residents (with propoxyphene used most often, long-acting opioids used infrequently, and frequent prn use) was inconsistent with recommended pain therapy in older people and attests to the urgent need to educate NF practitioners on the appropriate use of analgesics.
确定在护理机构（NFs）中最常开具特定镇痛药的医疗状况，描述药物和非药物疼痛治疗方法的使用情况，并确定NFs居民疼痛评估的频率和质量。
由顾问药师进行的一项为期3个月的多中心回顾性药物使用评估。
89家NFs，其患者普查中不超过25%为特殊人群（如头部创伤患者）。
共有2065名成年NFs居民接受了至少一种特定镇痛药。
记录镇痛药的主要适应证、疼痛类型、疼痛评估方法、疼痛的非药物治疗、开具的镇痛药和治疗方案以及合并症。
共有54.3%的居民有一项镇痛药治疗适应证，31.0%有两项适应证，14.7%有三项或更多适应证。关节炎是最常见的镇痛药适应证（41.7%的居民），其次是骨折（占12.4%）和其他肌肉骨骼疾病（占9.7%）。据报告，慢性疼痛的居民（占76.8%）多于急性疼痛的居民（占19.9%），3.0%的居民同时患有慢性和急性疼痛。0.2%的居民疼痛类型不明。观察性疼痛评估的使用频率更高（55.9%的居民），高于客观评估方法（16.6%），40.6%的居民未进行疼痛评估。大多数居民（69.4%）未接受疼痛的非药物治疗。在2542张阿片类药物和非甾体抗炎药（NSAID）处方中，67.6%为阿片类药物，24.8%为NSAIDs，7.6%为曲马多。含丙氧芬的药物是最常开具的阿片类药物组，丙氧芬与对乙酰氨基酚是最常开具的镇痛药（占所有镇痛药的35.6%）。大多数镇痛药（63.2%）是按需（prn）开具的。
研究结果表明疼痛评估不足、非药物干预使用较少以及镇痛药使用不当。客观评估慢性疼痛的居民比例较小，这表明在NFs中监测疼痛进展存在困难。大多数居民镇痛药的处方（丙氧芬使用最频繁，长效阿片类药物使用较少，且频繁按需使用）与老年人推荐的疼痛治疗不一致，证明迫切需要对NFs从业者进行镇痛药合理使用方面的教育。
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