Passik Steven D, Kirsh Kenneth L, Donaghy Kathleen B, Portenoy Russell K
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Clin J Pain. 2006 Feb;22(2):173-81. doi: 10.1097/01.ajp.0000161525.48245.aa.
This study evaluated the prevalence and correlates of aberrant drug-taking behaviors in two populations: patients with HIV-related pain and a history of substance abuse (n = 73) and patients with cancer pain and no history of substance abuse (n = 100).
All patients completed a Drug-Taking Behaviors Interview, the Brief Symptom Inventory (BSI), Brief Pain Inventory (BPI), Memorial Symptom Assessment Scale (MSAS), and the Marlowe Crowne Social Desirability Scale (MCSDS). The Pain Management Index was calculated to assess the adequacy of opioid prescribing.
The cancer sample comprised 38 men and 62 women, and the AIDS sample comprised 63 men and 10 women. Patients with AIDS-related pain had higher global distress on the MSAS (F1, 170 = 20.05, P < 0.001), greater pain-related interference in their daily functioning on the BPI (F1, 161 = 22.87, P < 0.001), and a lower percentage of relief from their current medications (F1, 156 = 76.14, P < 0.001). AIDS patients also reported more than twice as many examples of aberrant drug-related behaviors per patient (mean = 6.14, SD = 4.60) as the cancer patients (mean = 1.42, SD = 1.91).
These data suggest that AIDS patients with histories of substance abuse receiving opioid therapy are more symptomatic, have more distress, experience more interference from residual pain, and engage in more problematic drug-related behaviors than patients with no history of drug abuse receiving opioids for cancer pain. Treatment of substance abusers with pain requires skills that complement best practices in opioid prescribing. Better approaches to the long-term treatment of these populations are needed.
本研究评估了两类人群中异常用药行为的患病率及其相关因素：有HIV相关疼痛且有药物滥用史的患者（n = 73）和有癌症疼痛且无药物滥用史的患者（n = 100）。
所有患者均完成了用药行为访谈、简明症状量表（BSI）、简明疼痛量表（BPI）、纪念症状评估量表（MSAS）以及马洛-克劳恩社会赞许性量表（MCSDS）。计算疼痛管理指数以评估阿片类药物处方的合理性。
癌症样本包括38名男性和62名女性，艾滋病样本包括63名男性和10名女性。患有艾滋病相关疼痛的患者在MSAS上的总体痛苦程度更高（F1, 170 = 20.05，P < 0.001），在BPI上与疼痛相关的日常功能干扰更大（F1, 161 = 22.87，P < 0.001），且当前药物缓解疼痛的比例更低（F1, 156 = 76.14，P < 0.001）。艾滋病患者报告的每位患者异常药物相关行为的例子数量也比癌症患者多两倍以上（平均值 = 6.14，标准差 = 4.60）（平均值 = 1.42，标准差 = 1.91）。
这些数据表明，与接受阿片类药物治疗癌症疼痛且无药物滥用史的患者相比，有药物滥用史且接受阿片类药物治疗的艾滋病患者症状更明显，痛苦更多，残余疼痛的干扰更大，且存在更多有问题的药物相关行为。治疗有疼痛的药物滥用者需要补充阿片类药物处方最佳实践的技能。需要更好的方法来对这些人群进行长期治疗。
