定时给药与疼痛相关的阿片类药物剂量滴定在慢性阿片类药物治疗中的比较。
Time-scheduled vs. pain-contingent opioid dosing in chronic opioid therapy.
机构信息
Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA Department of Biostatistics, University of Washington School of Public Health,1959 NE Pacific Street, Seattle, WA 98195, USA Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA Division of Research, Kaiser Permanente of Northern California, 2000 Broadway, Oakland, CA 94612, USA Department of Psychiatry, University of California, 513 Parnassus Avenue, San Francisco, CA 94143, USA.
出版信息
Pain. 2011 Jun;152(6):1256-1262. doi: 10.1016/j.pain.2011.01.005. Epub 2011 Feb 5.
Some expert guidelines recommend time-scheduled opioid dosing over pain-contingent dosing for patients receiving chronic opioid therapy (COT). The premise is that time-scheduled dosing results in more stable opioid blood levels and better pain relief, fewer adverse effects, less reinforcement of pain behaviors, and lower addiction risk. We report results of a survey of 1781 patients receiving COT for chronic noncancer pain, in which 967 reported time-scheduled opioid dosing only and 325 reported pain-contingent opioid dosing only. Opioid-related problems and concerns were assessed with the Prescribed Opioids Difficulties Scale. We hypothesized that respondents using time-scheduled opioid dosing would report significantly fewer problems and concerns than those using pain-contingent dosing. Patients receiving time-scheduled dosing received substantially higher average daily opioid doses than those using pain-contingent dosing (97.2 vs. 37.2mg average daily dose morphine equivalents, P < .0001). Contrary to expectation, time-scheduled opioid dosing was associated with higher levels of patient opioid control concerns than pain-contingent dosing (6.2 vs. 4.8, P=.008), after adjusting for patient and drug regimen differences. Opioid-related psychosocial problems were somewhat greater among patients using time-scheduled dosing, but this difference was nonsignificant after controlling for patient and drug regimen differences (5.9 vs. 5.0, P=.14). Time-scheduled dosing typically involved higher dosage levels and was associated with higher levels of patient concerns about opioid use. Controlled comparative effectiveness research is needed to assess benefits and risks of time-scheduled opioid dosing relative to pain-contingent opioid dosing among COT patients in ambulatory care. Patients with time-scheduled dosing received higher opioid dosage than patients with pain-contingent dosing. Time-scheduled dosing was associated with greater opioid control concerns than pain-contingent dosing.
一些专家指南建议对接受慢性阿片类药物治疗（COT）的患者进行定时阿片类药物剂量滴定，而不是根据疼痛情况进行剂量滴定。其前提是定时剂量滴定可使阿片类药物血药水平更稳定，从而更好地缓解疼痛，减少不良反应，减少对疼痛行为的强化作用，降低成瘾风险。我们报告了对 1781 名接受慢性非癌痛 COT 治疗的患者进行的一项调查结果，其中 967 名患者仅报告定时阿片类药物剂量滴定，325 名患者仅报告疼痛相关阿片类药物剂量滴定。使用规定阿片类药物困难量表评估阿片类药物相关问题和关注点。我们假设使用定时阿片类药物剂量滴定的患者报告的问题和关注点明显少于使用疼痛相关阿片类药物剂量滴定的患者。接受定时阿片类药物剂量滴定的患者的平均每日阿片类药物剂量明显高于使用疼痛相关阿片类药物剂量滴定的患者（平均每日剂量吗啡当量 97.2 对 37.2mg，P <.0001）。与预期相反，调整患者和药物方案差异后，定时阿片类药物剂量滴定与患者对阿片类药物控制的担忧程度高于疼痛相关阿片类药物剂量滴定相关（6.2 对 4.8，P=.008）。使用定时阿片类药物剂量滴定的患者的阿片类药物相关心理社会问题稍多，但在控制患者和药物方案差异后，这种差异无统计学意义（5.9 对 5.0，P=.14）。定时阿片类药物剂量滴定通常涉及更高的剂量水平，并与患者对阿片类药物使用的担忧程度较高相关。需要进行对照性有效性研究，以评估在门诊环境中接受 COT 的患者中，与疼痛相关阿片类药物剂量滴定相比，定时阿片类药物剂量滴定的益处和风险。接受定时阿片类药物剂量滴定的患者接受的阿片类药物剂量高于接受疼痛相关阿片类药物剂量滴定的患者。定时阿片类药物剂量滴定与疼痛相关阿片类药物剂量滴定相比，与更大的阿片类药物控制担忧相关。
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