Kovac Stacey H, Saag Kenneth G, Curtis Jeffrey R, Allison Jeroan
Durham VA Medical Center, Durham, North Carolina 27705, USA.
Arthritis Rheum. 2008 Feb 15;59(2):227-33. doi: 10.1002/art.23336.
Inadequate prescription therapy pain management, lack of doctor-patient communication about over-the-counter (OTC) medications, and easy accessibility of OTC medications may contribute to patients using more than 1 medication to manage pain. It is well established that taking multiple nonsteroidal antiinflammatory drugs (NSAIDs) can lead to serious gastrointestinal problems. Little is known about whether use of more than 1 NSAID (i.e., dual use) is related to patient self-reported outcomes, specifically health-related quality of life (HRQOL). We hypothesized that dual use of NSAIDs would be associated with reduced HRQOL.
Patients from a managed care organization who filled > or =1 NSAID prescription over a 6-month period were eligible for a telephone interview focusing on NSAID use, which included the Short Form 12 (SF-12) Health Survey. Dual use was defined as taking 2 NSAIDs, either prescription or OTC, at least twice weekly during the past month. A multivariable linear regression model examined the association between dual use and the Physical Component Summary score (PCS-12) from the SF-12.
Dual use was associated with lower PCS-12 scores indicating poorer HRQOL, after controlling for clinical and demographic factors.
Patients may self-manage their pain to improve their daily activities by taking more than 1 NSAID. However, by attempting to obtain symptom relief, patients may be putting themselves at risk for complications. Providers are likely unaware of patients' risk. Future research should evaluate the causal factors contributing to dual use.
处方治疗疼痛管理不足、医患之间缺乏关于非处方药（OTC）的沟通以及非处方药易于获取，可能导致患者使用不止一种药物来管理疼痛。众所周知，服用多种非甾体抗炎药（NSAIDs）会导致严重的胃肠道问题。对于使用不止一种NSAID（即双重使用）是否与患者自我报告的结果相关，特别是与健康相关的生活质量（HRQOL），人们知之甚少。我们假设NSAIDs的双重使用与HRQOL降低有关。
来自一家管理式医疗组织的患者，在6个月内开具了≥1份NSAID处方，有资格接受一次电话访谈，重点是NSAID的使用情况，其中包括简短健康调查问卷12项（SF - 12）。双重使用被定义为在过去一个月内每周至少两次服用两种NSAIDs，无论是处方药还是非处方药。一个多变量线性回归模型检验了双重使用与SF - 12中的身体成分汇总得分（PCS - 12）之间的关联。
在控制了临床和人口统计学因素后，双重使用与较低的PCS - 12得分相关，表明HRQOL较差。
患者可能通过服用不止一种NSAID来自我管理疼痛，以改善日常活动。然而，为了缓解症状，患者可能会使自己面临并发症的风险。医疗服务提供者可能并未意识到患者的风险。未来的研究应该评估导致双重使用的因果因素。
