Rosenblum Andrew, Joseph Herman, Fong Chunki, Kipnis Steven, Cleland Charles, Portenoy Russell K
Institute for Treatment and Services Research, National Development and Research Institutes, New York, NY 10010, USA.
JAMA. 2003 May 14;289(18):2370-8. doi: 10.1001/jama.289.18.2370.
Little is known about the prevalence and characteristics of chronic pain among patients with different types of chemical dependency.
To estimate the prevalence and to examine the characteristics of chronic severe pain in chemically dependent populations receiving methadone maintenance or inpatient residential treatment.
DESIGN, SETTING, AND PARTICIPANTS: Representative samples of 390 patients from 2 methadone maintenance treatment programs (MMTPs) and 531 patients from 13 short-term residential substance abuse treatment (inpatient) programs, all in New York State, were surveyed in late 2000 and early 2001.
Prevalence of chronic severe pain, defined as pain that persisted for more than 6 months and was of moderate to severe intensity or that significantly interfered with daily activities.
Chronic severe pain was experienced by 37% of MMTP patients (95% confidence interval [CI], 32%-41%) and 24% of inpatients (95% CI, 20%-28%; P =.03). Pain of any type or duration during the past week was reported by 80% of MMTP patients and 78% of inpatients. Among those with chronic severe pain, 65% of MMTP patients and 48% of inpatients reported high levels of pain-related interference in physical and psychosocial functioning. Among MMTP patients, correlates of chronic pain in a multivariate model were age (odds ratio [OR], 2.08; 95% CI, 1.17-3.70), chronic illness (OR, 1.88; 95% CI, 1.07-3.29), lifetime psychiatric illness (OR, 1.77; 95% CI, 1.06-2.97), psychiatric distress (OR, 1.63; 95% CI, 1.22-2.18), and time in treatment (OR, 2.23; 95% CI, 1.06-4.68). Among inpatients, the correlates of chronic pain were race (blacks vs whites: OR, 0.52; 95% CI, 0.31-0.90; Hispanics vs whites: OR, 0.48; 95% CI, 0.24-0.95), drug craving (OR, 2.78; 95% CI, 1.54-5.02), chronic illness (OR, 2.17; 95% CI, 1.37-3.43), and psychiatric distress (OR, 1.36; 95% CI, 1.03-1.81). Among those with chronic severe pain, inpatients were significantly more likely than MMTP patients to have used illicit drugs, as well as alcohol, to treat their pain complaint (51% vs 34%, P =.005) but were less likely to have been prescribed pain medications (52% vs 67%, P =.01).
Chronic severe pain is prevalent among patients in substance abuse treatment, especially MMTP patients. Pain is associated with functional impairment and correlates of pain vary with the population. Self-medication for pain with psychoactive drugs appears especially problematic among substance users who enroll in drug-free treatment programs. Substance abuse treatment programs need to develop comprehensive and structured pain management programs.
对于不同类型化学物质依赖患者中慢性疼痛的患病率及特征，人们了解甚少。
估计接受美沙酮维持治疗或住院戒毒治疗的化学物质依赖人群中慢性重度疼痛的患病率，并研究其特征。
设计、地点和参与者：2000年末至2001年初，对纽约州2个美沙酮维持治疗项目（MMTPs）中的390名患者以及13个短期住院戒毒治疗项目中的531名患者进行了抽样调查。
慢性重度疼痛的患病率，定义为持续超过6个月、强度为中度至重度或严重干扰日常活动的疼痛。
MMTP患者中有37%经历过慢性重度疼痛（95%置信区间[CI]，32%-41%），住院患者中有24%经历过（95%CI，20%-28%；P = 0.03）。80%的MMTP患者和78%的住院患者报告在过去一周内有任何类型或持续时间的疼痛。在患有慢性重度疼痛的患者中，65%的MMTP患者和48%的住院患者报告疼痛对身体和心理社会功能有高度干扰。在MMTP患者中，多变量模型中慢性疼痛的相关因素包括年龄（优势比[OR]，2.08；95%CI，1.17-3.70）、慢性病（OR，1.88；95%CI，1.07-3.29）、终生精神疾病（OR，1.77；95%CI，1.06-2.97）、精神痛苦（OR，1.63；95%CI，1.22-2.18）以及治疗时间（OR，2.23；95%CI，1.06-4.68）。在住院患者中，慢性疼痛的相关因素包括种族（黑人与白人：OR，0.52；95%CI，0.31-0.90；西班牙裔与白人：OR，0.48；95%CI，0.24-0.95）、药物渴求（OR，2.78；95%CI，1.54-5.02）、慢性病（OR，2.17；95%CI，1.37-3.43）以及精神痛苦（OR，1.36；95%CI，1.03-1.81）。在患有慢性重度疼痛的患者中，住院患者比MMTP患者更有可能使用非法药物以及酒精来缓解疼痛（51%对34%，P = 0.005），但开具止痛药物的可能性较小（52%对67%，P = 0.01）。
慢性重度疼痛在药物滥用治疗患者中普遍存在，尤其是MMTP患者。疼痛与功能损害相关，且疼痛的相关因素因人群而异。在参加无毒品治疗项目的药物使用者中，使用精神活性药物自我治疗疼痛似乎尤其成问题。药物滥用治疗项目需要制定全面且结构化的疼痛管理项目。
