Caldeiro Ryan M, Malte Carol A, Calsyn Donald A, Baer John S, Nichol Paul, Kivlahan Daniel R, Saxon Andrew J
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA.
Addiction. 2008 Dec;103(12):1996-2005. doi: 10.1111/j.1360-0443.2008.02358.x. Epub 2008 Oct 8.
To estimate the prevalence of persistent pain among veterans in out-patient addiction treatment and examine associated addiction treatment outcomes and medical and psychiatric service use.
DESIGN, SETTING AND PARTICIPANTS: Analysis of data from a prospective randomized controlled trial comparing on-site versus referral primary care of veterans with substance dependence (n = 582), excluding opioid dependence who had at least one follow-up interview during the 12-month study period in a Veterans Affairs (VA) out-patient addiction treatment center.
Pain status was classified as persistent (pain was rated moderate to very severe at all time-points), low (pain was rated none to mild at all time-points) or intermittent (all others). Main outcome measures were addiction treatment retention, addiction severity index (ASI) alcohol and drug composite scores, VA service utilization and treatment costs.
A total of 33.2% of veterans reported persistent pain and 47.3% reported intermittent pain. All groups benefited from addiction treatment, but veterans with persistent pain were in treatment for an estimated 35.1 fewer days [95% confidence interval (CI) = -64.1, -6.1, P = 0.018], less likely to be abstinent from alcohol or drugs at 12 months [odds ratio (OR)(adj) = 0.52; 95% CI = 0.30,0.89; P = 0.018], had worse ASI alcohol composite scores at 12 months (beta(adj) = 0.09; 95% CI = 0.02,0.15; P = 0.007), were more likely to be medically hospitalized (OR(adj) = 2.70; 95% CI = 1.02,7.13; P = 0.046) and had higher total service costs compared to those with low pain ($17 766 versus $13 261, P = 0.012).
Persistent pain is common among veterans in out-patient addiction treatment and is associated with poorer rates of abstinence, worse alcohol use severity and greater service utilization and costs than those with low pain.
评估门诊成瘾治疗退伍军人中持续性疼痛的患病率，并研究相关的成瘾治疗结果以及医疗和精神科服务的使用情况。
设计、地点和参与者：对一项前瞻性随机对照试验的数据进行分析，该试验比较了物质依赖退伍军人的现场初级保健与转诊初级保健（n = 582），排除在退伍军人事务部（VA）门诊成瘾治疗中心12个月研究期间至少接受过一次随访访谈的阿片类药物依赖者。
疼痛状态分为持续性（在所有时间点疼痛评分为中度至非常严重）、低度（在所有时间点疼痛评分为无至轻度）或间歇性（其他所有情况）。主要结局指标为成瘾治疗留存率、成瘾严重程度指数（ASI）酒精和药物综合评分、VA服务利用率和治疗成本。
共有33.2%的退伍军人报告有持续性疼痛，47.3%报告有间歇性疼痛。所有组都从成瘾治疗中获益，但持续性疼痛的退伍军人接受治疗的天数估计少35.1天[95%置信区间（CI）=-64.1，-6.1，P = 0.018]，在12个月时戒酒或戒毒的可能性较小[调整后的优势比（OR）= 0.52；95% CI = 0.30，0.89；P = 0.018]，12个月时ASI酒精综合评分更差（调整后的β = 0.09；95% CI = 0.02，0.15；P = 0.007），更有可能因医疗原因住院（调整后的OR = 2.70；95% CI = 1.02，7.13；P = 0.046），与低度疼痛者相比，总服务成本更高（17766美元对13261美元，P = 0.012）。
在门诊成瘾治疗的退伍军人中，持续性疼痛很常见，与低度疼痛者相比，其戒酒率更低、酒精使用严重程度更差、服务利用率更高且成本更高。
