Toronto Western Hospital, Toronto, ON M5T 2S8, Canada.
Can Fam Physician. 2011 Mar;57(3):e97-105.
To describe the characteristics of patients with chronic noncancer pain (CNCP) prescribed opioids by community physicians and referred to a tertiary pain clinic.
Cross-sectional, descriptive study.
A tertiary care, hospital-based pain clinic in Toronto, Ont.
A total of 455 consecutive patients newly referred to the pain clinic by community physicians.
Data on demographic characteristics, pain ratings, and medication intake were obtained using standardized collection forms and retrospective chart review. Patients were classified by diagnosis: group 1 patients had biomedical disorders only, group 2 patients had biomedical disorders and psychological factors, and group 3 patients had psychological factors only. Patients were also categorized based on opioid use: no opioid use (NOU); low opioid use (LOU), with a daily morphine-equivalent dosage (MED) of 200 mg or less; or high opioid use (HOU), with a daily MED of more than 200 mg.
In the general study population, 63% of patients were taking opioids, with 1 in 5 exceeding an MED of 200 mg daily. In group 1, 59% of patients used opioids and 10% had HOU; 66% of patients in groups 2 and 3 were taking opioids, with 21% and 26% classified as having HOU. The mean (SD) daily MED for groups 2 and 3 HOU patients combined was significantly higher than that of group 1 HOU patients: 575.7 (472.9) mg/d versus 284.9 (74.6) mg/d, respectively. Men were twice as likely as women to have HOU; Canadian-born patients were 3 times as likely as foreign-born patients to have HOU. Psychoactive drugs were coprescribed in 61% of LOU patients and 76% of HOU patients. Greater opioid use was associated with group 2 and 3 diagnoses, male sex, Canadian-born origin, and high pain scores.
Our results indicate that male, Canadian-born CNCP patients presenting with psychological morbidity or comorbidity and reporting higher pain severity ratings were more likely to receive opioids. Additionally, many CNCP patients referred to our tertiary care pain clinic were receiving opioids in excess of a 200-mg/d MED. More studies are needed to determine which factors lead to high-dose opioid prescribing in a subset of this CNCP population.
描述社区医生开具阿片类药物处方并转介至三级疼痛诊所的慢性非癌性疼痛（CNCP）患者的特征。
横断面、描述性研究。
安大略省多伦多市一家三级保健、医院为主的疼痛诊所。
共纳入 455 例新转至疼痛诊所的社区医生患者。
使用标准化采集表和回顾性图表审查获取人口统计学特征、疼痛评分和药物摄入数据。根据诊断对患者进行分类：第 1 组患者仅有生物医学障碍，第 2 组患者既有生物医学障碍又有心理因素，第 3 组患者仅有心理因素。还根据阿片类药物使用情况对患者进行分类：未使用阿片类药物（NOU）；低剂量阿片类药物使用（LOU），每日吗啡等效剂量（MED）为 200 mg 或以下；高剂量阿片类药物使用（HOU），每日 MED 超过 200 mg。
在一般研究人群中，63%的患者正在服用阿片类药物，其中 1/5 的患者每日 MED 超过 200 mg。第 1 组中，59%的患者使用阿片类药物，10%的患者为 HOU；第 2 组和第 3 组中 66%的患者正在服用阿片类药物，其中 21%和 26%的患者被归类为 HOU。第 2 组和第 3 组 HOU 患者的每日 MED 均值（SD）分别明显高于第 1 组 HOU 患者：分别为 575.7（472.9）mg/d 和 284.9（74.6）mg/d。男性服用 HOU 的可能性是女性的两倍；与外国出生的患者相比，加拿大出生的患者服用 HOU 的可能性是其 3 倍。LOU 患者中有 61%和 HOU 患者中有 76%合用了精神活性药物。更高的阿片类药物使用与第 2 组和第 3 组诊断、男性、加拿大出生和较高的疼痛评分相关。
我们的研究结果表明，患有 CNCP 的男性、加拿大出生的患者，若存在心理病态或合并症且报告更高的疼痛严重程度评分，则更有可能接受阿片类药物治疗。此外，许多被转介至我们的三级保健疼痛诊所的 CNCP 患者的每日 MED 超过 200 mg。需要开展更多研究以确定哪些因素导致 CNCP 人群中的这一部分患者开出高剂量阿片类药物处方。
