Medical Department, Grünenthal Pharma SA, Madrid, Spain.
J Med Econ. 2011;14(5):568-75. doi: 10.3111/13696998.2011.598202. Epub 2011 Jul 6.
The relationship between chronic noncancer pain (CNCP) control and pain medication (analgesic) adherence has not been widely documented. The primary aim of this study was to evaluate the relationship between pain intensity and the degree of adherence to analgesic medication prescribed in pain clinics. There was also a special emphasis on the influence of polypharmacy on adherence.
A cross-sectional clinical survey was carried out in pain clinics across Spain. Demographic and clinical data were collected from patients: pain intensity, analgesic prescription and adherence, and the presence of concomitant medical conditions and treatments. The relationship between analgesic adherence and pain intensity was analyzed using correlations and propensity scores based on ordinal logistic regression. Correlates of pain intensity were explored using multiple linear regression.
Data was gathered from 1407 patients; 1321 were eligible for analysis. Their mean (standard deviation) age was 61.6 (14.7) years and the majority (67.3%) were women. More than half (57.9%) received step 3 analgesics. Pain intensity was scored 5 out of 10 on average. Just 65.9% of patients were reported to not have missed any analgesic dose during the previous week. Pain intensity correlated negatively with analgesic adherence (r(s) = -0.151, p < 0.001). Moderate versus very intense pain was predicted in patients with 'good' and 'very poor' adherence, respectively. The presence of concomitant medications also correlated negatively with analgesic adherence (r(s) = -0.074, p = 0.007). However, few investigators reported such a negative effect of polypharmacy.
Key limitations of this research are its cross-sectional design and the absence of an objective means of measuring medication adherence.
This study has shown that there is a small but significant inverse relationship between analgesic adherence and CNCP control, which has remained elusive to date and should be further evaluated. Polypharmacy also had a negative influence on adherence, although this was not acknowledged by all investigators.
慢性非癌性疼痛（CNCP）控制与疼痛药物（镇痛药）依从性之间的关系尚未得到广泛证实。本研究的主要目的是评估疼痛强度与疼痛诊所开具的镇痛药依从性程度之间的关系。特别强调了多药治疗对依从性的影响。
在西班牙各地的疼痛诊所进行了横断面临床调查。从患者中收集人口统计学和临床数据：疼痛强度、镇痛药处方和依从性，以及并存的医疗条件和治疗方法。使用基于有序逻辑回归的相关性和倾向评分分析了镇痛药依从性与疼痛强度之间的关系。使用多元线性回归探讨了疼痛强度的相关因素。
共收集了 1407 名患者的数据；其中 1321 名符合分析条件。他们的平均（标准差）年龄为 61.6（14.7）岁，大多数（67.3%）为女性。超过一半（57.9%）接受了第 3 步镇痛药治疗。疼痛强度平均评分为 5 分（满分 10 分）。只有 65.9%的患者报告在上周没有错过任何一剂镇痛药。疼痛强度与镇痛药依从性呈负相关（r(s) = -0.151，p < 0.001）。在“良好”和“非常差”依从性的患者中，分别预测为中度疼痛和非常剧烈疼痛。并存药物的存在也与镇痛药依从性呈负相关（r(s) = -0.074，p = 0.007）。然而，很少有研究人员报告多药治疗有这种负面影响。
本研究的主要局限性是其横断面设计以及缺乏客观的药物依从性测量方法。
本研究表明，镇痛药依从性与 CNCP 控制之间存在微小但显著的负相关关系，这是迄今为止尚未解决的问题，需要进一步评估。多药治疗也对依从性产生了负面影响，尽管并非所有研究人员都承认这一点。
