Wilsey Barth L, Fishman Scott M, Tsodikov Alexander, Ogden Christine, Symreng Ingela, Ernst Amy
Department of Anesthesiology and Pain Medicine, and VA Northern California Health Care System, University of California, Davis, CA, USA.
Pain Med. 2008 Nov;9(8):1107-17. doi: 10.1111/j.1526-4637.2007.00401.x. Epub 2008 Feb 5.
We attempted to identify psychological comorbidities that are associated with the propensity for prescription opioid abuse.
Patients presenting to an emergency department seeking opioid refills for chronic pain were evaluated with five validated self-report instruments and structured clinical interviews. The potential for prescription opioid abuse was modeled with multiple regression analysis using depression, anxiety disorders, personality disorder, and addiction as independent variables.
Of the 113 patients studied, 91 (81%) showed a propensity for prescription opioid abuse as determined by scores on the Screener and Opioid Assessment for Patients with Pain instrument. Depression, anxiety, and a history of substance were common and panic attacks, posttraumatic stress disorder, and personality disorders were also found, albeit less frequently. Panic attacks, trait anxiety, and the presence of a personality disorder accounted for 38% of the variance in the potential for prescription opioid abuse.
Patients in chronic pain should be assessed for psychological and addiction disorders because they are at increased risk for abusing opioids. They should also be referred for psychosocial treatment as part of their care, where appropriate.
我们试图确定与处方阿片类药物滥用倾向相关的心理共病。
对到急诊科寻求慢性疼痛阿片类药物续方的患者，使用五种经过验证的自我报告工具和结构化临床访谈进行评估。以抑郁、焦虑症、人格障碍和成瘾作为自变量，采用多元回归分析对处方阿片类药物滥用的可能性进行建模。
在研究的113名患者中，91名（81%）根据疼痛患者筛查和阿片类药物评估工具的得分显示有处方阿片类药物滥用倾向。抑郁、焦虑和物质使用史很常见，惊恐发作、创伤后应激障碍和人格障碍也有发现，尽管频率较低。惊恐发作、特质焦虑和人格障碍的存在占处方阿片类药物滥用可能性差异的38%。
慢性疼痛患者应接受心理和成瘾障碍评估，因为他们滥用阿片类药物的风险增加。在适当情况下，还应将他们转介接受心理社会治疗作为其护理的一部分。
