带状疱疹后神经痛患者加巴喷丁治疗开始后阿片类药物使用情况的变化。

Change in opioid use after the initiation of gabapentin therapy in patients with postherpetic neuralgia.

作者信息

Berger Ariel, Dukes Ellen, McCarberg Bill, Liss Marty, Oster Gerry

机构信息

Policy Analysis Inc., Brookline, Massachusetts 02445, USA.

出版信息

Clin Ther. 2003 Nov;25(11):2809-21. doi: 10.1016/s0149-2918(03)80335-1.

DOI:10.1016/s0149-2918(03)80335-1

PMID:14693306

Abstract

BACKGROUND

Postherpetic neuralgia (PHN) is a chronic painful disorder that sometimes develops after an acute episode of herpes zoster infection (shingles) and can be difficult to treat. Although opioids are sometimes effective for chronic neuropathic pain, adverse effects are common, particularly among the elderly, and may cause many patients to discontinue therapy.

OBJECTIVE

This study examined changes in opioid use after the initiation of gabapentin therapy in patients with PHN.

METHODS

A health insurance claims database was used to identify all persons aged >or= 18 years who began therapy with gabapentin in 2000 or 2001 and had either (1) >or=2 medical claims with a diagnosis of PHN during the 6-month period before the first receipt of gabapentin (index date) or (2) 1 such claim <or=14 days before the index date. Persons who were not continuously eligible for medical and drug benefits for 6 months before and after the index date (pretreatment and follow-up, respectively) were dropped from the study sample. Use of opioids, including both short- and long-acting formulations, was compared between pretreatment and follow-up. Patients were stratified in the study analyses by whether they received 1 or >or=2 prescriptions for gabapentin.

RESULTS

Forty-five patients with PHN began therapy with gabapentin during the period of interest; 35 (77.8%) received >or=2 prescriptions for gabapentin. The proportion of patients receiving opioids decreased significantly between pretreatment and follow-up (from 88.9% to 71.1%; P = 0.03); the mean number of opioid prescriptions per patient also decreased significantly (from 3.9 to 3.0; P = 0.03). These reductions were observed only in patients who received >or=2 prescriptions for gabapentin; there was no significant change in opioid use among those who received only 1 prescription for gabapentin.

CONCLUSION

In this study, initiation of gabapentin therapy in patients with PHN was associated with a reduction in the use of opioid analgesics.

摘要

背景

带状疱疹后神经痛（PHN）是一种慢性疼痛性疾病，有时在带状疱疹感染（带状疱疹）急性发作后出现，且难以治疗。尽管阿片类药物有时对慢性神经性疼痛有效，但不良反应很常见，尤其是在老年人中，可能导致许多患者停止治疗。

目的

本研究调查了加巴喷丁治疗开始后PHN患者阿片类药物使用情况的变化。

方法

使用一个医疗保险理赔数据库来识别所有年龄≥18岁且在2000年或2001年开始使用加巴喷丁治疗的人，这些人要么（1）在首次接受加巴喷丁治疗（索引日期）前6个月内有≥2次诊断为PHN的医疗理赔，要么（2）在索引日期前≤14天有1次这样的理赔。在索引日期前后6个月（分别为预处理期和随访期）未持续符合医疗和药物福利资格的人被排除在研究样本之外。比较预处理期和随访期阿片类药物的使用情况，包括短效和长效制剂。在研究分析中，根据患者接受1次还是≥2次加巴喷丁处方对患者进行分层。

结果

45例PHN患者在感兴趣的时间段内开始使用加巴喷丁治疗；35例（77.8%）接受了≥2次加巴喷丁处方。预处理期和随访期接受阿片类药物治疗的患者比例显著下降（从88.9%降至71.1%；P = 0.03）；每位患者的阿片类药物处方平均数量也显著下降（从3.9降至3.0；P = 0.03）。这些减少仅在接受≥2次加巴喷丁处方的患者中观察到；接受仅1次加巴喷丁处方的患者阿片类药物使用情况无显著变化。