Wasan Ajay D, Butler Stephen F, Budman Simon H, Benoit Christine, Fernandez Kathrine, Jamison Robert N
Pain Management Center, Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02467, USA.
Clin J Pain. 2007 May;23(4):307-15. doi: 10.1097/AJP.0b013e3180330dc5.
To investigate the role of psychiatric history and psychologic adjustment on aberrant drug-related behavior among patients prescribed opioids for noncancer pain.
Two hundred twenty-eight patients prescribed opioids for chronic pain were classified as either high or low on psychiatric morbidity on the basis of their responses on the psychiatric subscale of the Prescription Drug Use Questionnaire (PDUQ). They also completed the Brief Pain Inventory (BPI), Screener and Opioid Assessment for Pain Patients (SOAPP), and the Current Medication Misuse Measure (COMM). Patients were followed for 5 months and submitted a urine toxicology screen, and their treating physician completed the Prescription Opioid Therapy Questionnaire (POTQ). On the basis of the results from the SOAPP, COMM, POTQ, and urine screens, patients were classified as positive or negative on the Drug Misuse Index (DMI).
One hundred and three (N=103) of the patients (45%) were classified in the low psychiatric group (Low Psych) whereas 55% (N=125) were classified in the high psychiatric morbidity group (High Psych). High Psych patients were significantly younger than Low Psych patients and had been taking opioids longer (P<0.05). The High Psych group showed significantly higher SOAPP and COMM scores than the Low Psych patients (P<0.001), had a greater frequency of abnormal urine toxicology screens (P<0.01), and significantly higher scores on the DMI (P<0.001). A consistent association was found between psychiatric morbidity and prescription opioid misuse in chronic pain patients.
Psychiatric factors, such as a history of mood disorder, psychologic problems, and psychosocial stressors, may place patients at risk for misuse of prescription opioids. Future studies to elucidate the risk of medication misuse and aberrant drug behavior among this patient population are needed.
探讨精神病史和心理调适对非癌性疼痛患者使用阿片类药物时异常药物相关行为的作用。
228例因慢性疼痛而使用阿片类药物的患者，根据其在《处方药使用问卷》（PDUQ）精神科分量表上的回答，被分为精神疾病发病率低或高两组。他们还完成了《简明疼痛问卷》（BPI）、《疼痛患者筛选与阿片类药物评估》（SOAPP）以及《当前药物滥用测量》（COMM）。对患者进行了5个月的随访，并进行了尿液毒理学筛查，其主治医生完成了《处方阿片类药物治疗问卷》（POTQ）。根据SOAPP、COMM、POTQ和尿液筛查结果，患者在药物滥用指数（DMI）上被分为阳性或阴性。
103例（N = 103）患者（45%）被归为低精神疾病组（低精神组），而55%（N = 125）被归为高精神疾病发病率组（高精神组）。高精神组患者比低精神组患者显著年轻，服用阿片类药物的时间更长（P < 0.05）。高精神组的SOAPP和COMM得分显著高于低精神组患者（P < 0.001），尿液毒理学筛查异常的频率更高（P < 0.01），DMI得分也显著更高（P < 0.001）。在慢性疼痛患者中，发现精神疾病发病率与处方阿片类药物滥用之间存在一致的关联。
精神因素，如情绪障碍史、心理问题和社会心理应激源，可能使患者面临滥用处方阿片类药物的风险。需要进一步开展研究，以阐明该患者群体中药物滥用和异常药物行为的风险。
