Federman Alex D, Litke Ann, Morrison R Sean
Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
Am J Geriatr Pharmacother. 2006 Dec;4(4):306-15. doi: 10.1016/j.amjopharm.2006.12.009.
Pain is a common, troubling symptom of various disorders, chronically affecting up to 11% of adults in the general public. Despite a growing emphasis on improving the quality of pain management and the increasing use of analgesics over the past 20 years, pain remains undertreated for patients in a variety of clinical settings. Elderly patients, in particular, have disproportionately low rates of adequate pain control compared with younger patients.
The goal of this article was to determine the association of age with analgesic use in outpatient settings.
Cross-sectional analyses of data from the 1999-2002 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were conducted. We modeled use of NSAIDs or opioids as a function of age using multivariable logistic regression. Adults (aged > or =18 years) with pain and an inflammatory or mechanical disorder of the back or joint seen in outpatient settings in the United States were included in the study.
From 1999 to 2002, 7273 outpatient hospital and community-based visits to physicians were recorded for adults with pain and a diagnosis of a back or joint disorder, representing approximately 34 million visits per year. Acetaminophen, NSAIDs, and opioids were reported for 3.7%, 28.8%, and 17.3% of visits, respectively. Individuals aged > or =75 years were more likely than those aged 18 to 54 years to use NSAIDs (adjusted odds ratio, 1.50; 95% CI, 1.15-1.97), an effect of the increasing use of cyclooxygenase-2 inhibitors among older patients. Older patients were less likely to use opioids (adjusted odds ratio, 0.49; 95% CI, 0.32-0.75).
In outpatient settings, elderly patients with pain and back or joint disorders tend to use NSAIDs more often and opioids less often than younger patients, suggesting that older patients may be receiving a poorer quality of pain management in outpatient settings.
疼痛是各种疾病常见且令人困扰的症状，长期影响着普通大众中高达11%的成年人。尽管在过去20年里越来越强调提高疼痛管理质量以及镇痛药使用的增加，但在各种临床环境中，患者的疼痛仍未得到充分治疗。特别是老年患者，与年轻患者相比，疼痛得到充分控制的比例低得不成比例。
本文的目的是确定门诊环境中年龄与镇痛药使用之间的关联。
对1999 - 2002年国家门诊医疗调查和国家医院门诊医疗调查的数据进行横断面分析。我们使用多变量逻辑回归将非甾体抗炎药（NSAIDs）或阿片类药物的使用作为年龄的函数进行建模。纳入在美国门诊环境中患有疼痛且患有背部或关节炎症或机械性疾病的成年人（年龄≥18岁）。
1999年至2002年，记录了7273例患有疼痛且被诊断为背部或关节疾病的成年人的门诊医院和社区就诊情况，每年约有3400万次就诊。对乙酰氨基酚、NSAIDs和阿片类药物的报告使用率分别为3.7%、28.8%和17.3%。年龄≥75岁的个体比18至54岁的个体更有可能使用NSAIDs（调整后的优势比为1.50；95%置信区间为1.15 - 1.97）——这是老年患者中越来越多地使用环氧化酶 - 2抑制剂的结果。老年患者使用阿片类药物的可能性较小（调整后的优势比为0.49；95%置信区间为0.32 - 0.75）。
在门诊环境中，患有疼痛和背部或关节疾病的老年患者比年轻患者更倾向于更频繁地使用NSAIDs，而较少使用阿片类药物，这表明老年患者在门诊环境中可能接受的疼痛管理质量较差。
