Brown Randall T, Zuelsdorff Megan, Fleming Michael
University of Wisconsin, Madison Medical School, Department of Family Medicine, Madison, USA.
J Opioid Manag. 2006 May-Jun;2(3):137-46. doi: 10.5055/jom.2006.0023.
Chronic opioid therapy is commonly prescribed for chronic nonmalignant pain. Few published data describe the adverse effects experienced by patients with chronic nonmalignant pain being treated by primary care physicians. A prevalence study was conducted on a sample of 1,009 patients (889 receiving chronic opioids) being treated by 235 primary care physicians. Standardized questionnaires and medical record reviews were used to assess rates of addiction, pain diagnosis and severity, opioid adverse effects, and mental health. The mean daily dose of opioids was 92 mg using a morphine-equivalent conversion. Side effects included constipation (40 percent), sleeping problems (25 percent), loss of appetite (23 percent), and sexual dysfunction (18 percent), with patients on daily opioids experiencing more side effects than subjects on intermittent medication. The Medical Outcomes Study Mental Health Inventory (MOS-MHI) cognitive functioning scale indicated poorer cognitive function in the overall sample of chronic pain patients as compared to a general clinical sample (delta x 95 percent CI = 9.28, 13.76). However, there were limited differences in MOS scores between chronic pain subjects on daily opioids vs. intermittent opioids vs. no prescription opioids. A regression model suggests that psychological measures and pain severity are more predictive of decrements in cognitive function than specific opioid preparations or daily opioid dose. Physicians should closely monitor patients for adverse effects and adequacy of pain control when using chronic opioid therapy for chronic pain treatment. Psychological health, an important predictor of cognitive dysfunction, is a particularly important measure to actively monitor and manage.
慢性阿片类药物疗法常用于治疗慢性非恶性疼痛。很少有已发表的数据描述初级保健医生治疗的慢性非恶性疼痛患者所经历的不良反应。对由235名初级保健医生治疗的1009名患者（889名接受慢性阿片类药物治疗）样本进行了一项患病率研究。使用标准化问卷和病历审查来评估成瘾率、疼痛诊断和严重程度、阿片类药物不良反应以及心理健康状况。使用吗啡等效转换后，阿片类药物的平均每日剂量为92毫克。副作用包括便秘（40%）、睡眠问题（25%）、食欲不振（23%）和性功能障碍（18%），每日服用阿片类药物的患者比间歇性用药的患者出现更多副作用。医学结果研究心理健康量表（MOS-MHI）认知功能量表显示，与一般临床样本相比，慢性疼痛患者总体样本的认知功能较差（差值x 95%置信区间=9.28，13.76）。然而，每日服用阿片类药物的慢性疼痛受试者与间歇性服用阿片类药物的受试者和未处方阿片类药物的受试者之间，MOS评分差异有限。一个回归模型表明，心理测量指标和疼痛严重程度比特定的阿片类药物制剂或每日阿片类药物剂量更能预测认知功能的下降。在使用慢性阿片类药物疗法治疗慢性疼痛时，医生应密切监测患者的不良反应和疼痛控制是否充分。心理健康是认知功能障碍的一个重要预测指标，是需要积极监测和管理的一项特别重要的指标。
