Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland Pharmacology Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland Leppävirta Health Centre, Leppävirta, Finland.
Pain. 2011 Mar;152(3):543-547. doi: 10.1016/j.pain.2010.11.003. Epub 2011 Jan 17.
The objective of this study was to investigate the national pattern of strong opioid use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland. All persons (n=28,093) with a diagnosis of AD in 2005 were identified by the Social Insurance Institution of Finland (SII). For each person with AD, the SII identified a comparison person individually matched in terms of age (±1year), sex, and region of residence. Records of all reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for reimbursed opioid use. The age of the persons with and without AD ranged from 42 to 101 (mean 80.0) years, with men comprising 32.2% (n=9048) of persons. The annual prevalence of reimbursed opioid use was 3.0% (n=273) and 3.8% (n=727) among men and women with AD, respectively. The use of all reimbursed opioids was lower among persons with AD compared with those without AD (adjusted OR 0.77, 95% CI 0.71 to 0.84). The use of strong opioids (adjusted OR 1.26, 95% CI 1.05 to 1.51) and fentanyl (adjusted OR 1.44, 95% CI 1.13 to 1.83) was higher among persons with AD. Our study did not assess the stage or severity of AD, nor the opioid doses prescribed. However, the results highlight the challenges associated with diagnosing and treating pain in this population, and the importance of balancing the risk of adverse drug reactions against the ease of transdermal administration. Use of opioid analgesics was lower among 28,089 persons with Alzheimer's disease (AD) compared with individually matched comparison persons without AD. However, use of strong opioids and transdermal fentanyl was more prevalent among persons with AD.
本研究旨在调查芬兰社区居住的阿尔茨海默病（AD）患者和非 AD 患者强阿片类药物使用的全国模式。通过芬兰社会保险机构（SII）确定了所有 2005 年被诊断为 AD 的患者（n=28093）。对于每位 AD 患者，SII 都会根据年龄（±1 岁）、性别和居住地为其匹配一位个体对照者。从芬兰国家处方登记处提取了 2005 年所有报销药物购买记录。使用条件逻辑回归计算了未调整和调整后的比值比（OR）和 95%置信区间（CI），以评估报销阿片类药物使用情况。AD 患者和非 AD 患者的年龄范围为 42 至 101 岁（平均 80.0 岁），其中男性占 32.2%（n=9048）。AD 患者中，男性和女性的年报销阿片类药物使用率分别为 3.0%（n=273）和 3.8%（n=727）。与非 AD 患者相比，AD 患者使用所有报销阿片类药物的比例较低（调整后的 OR 0.77，95%CI 0.71 至 0.84）。AD 患者使用强阿片类药物（调整后的 OR 1.26，95%CI 1.05 至 1.51）和芬太尼（调整后的 OR 1.44，95%CI 1.13 至 1.83）的比例更高。本研究并未评估 AD 的阶段或严重程度，也未评估开具的阿片类药物剂量。然而，研究结果突出了在这一人群中诊断和治疗疼痛所面临的挑战，以及平衡不良反应风险与经皮给药便利性的重要性。与未患 AD 的个体对照者相比，28089 名 AD 患者使用阿片类镇痛药的比例较低。然而，AD 患者使用强阿片类药物和经皮芬太尼的比例更高。
