Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA.
Clin Gastroenterol Hepatol. 2011 Dec;9(12):1078-85.e1. doi: 10.1016/j.cgh.2011.08.008. Epub 2011 Aug 18.
BACKGROUND & AIMS: Opioids are sometimes used to treat chronic abdominal pain. However, opioid analgesics have not been proven to be an effective treatment for chronic abdominal pain and have been associated with drug misuse, constipation, and worsening abdominal pain. We sought to estimate the national prescribing trends and factors associated with opioid prescribing for chronic abdominal pain.
Chronic abdominal pain-related visits by adults to US outpatient clinics were identified using reason-for-visit codes from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1997-2008). Data were weighted to produce national estimates of opioid prescriptions over time. Logistic regression analyses, adjusted for complex survey design, were performed to identify factors associated with opioid use.
The number of outpatient visits for chronic abdominal pain consistently decreased over time from 14.8 million visits (95% confidence interval [CI], 11.6-18.0 visits) in 1997 through 1999 to 12.2 million visits (95% CI, 9.0-15.6 visits) or 1863 visits per 100,000 population in 2006 through 2008 (P for trend = 0.04). Conversely, the adjusted prevalence of visits for which an opioid was prescribed increased from 5.9% (95% CI, 3.5%-8.3%) in 1997 through 1999 to 12.2% (95% CI, 7.5%-17.0%) in 2006 through 2008 (P = 0.03 for trend). Opioid prescriptions were most common among patients aged 25 to 40 years old (odds ratio [OR] 4.6; 95% CI, 1.2-18.4). Opioid prescriptions were less common among uninsured (OR 0.1; 95% CI, 0.04-0.40) and African American (OR 0.3; 95% CI, 0.1-0.9) patients.
From 1997 to 2008 opioid prescriptions for chronic abdominal pain more than doubled. Further studies are needed to better understand the reasons for and consequences of this trend.
阿片类药物有时被用于治疗慢性腹痛。然而，阿片类镇痛药并未被证明对慢性腹痛有效，并且与药物滥用、便秘和腹痛加重有关。我们试图评估全国阿片类药物处方的趋势以及与慢性腹痛处方相关的因素。
使用国家门诊医疗调查和国家医院门诊医疗调查的就诊原因代码，确定成年人因慢性腹痛到美国门诊就诊的情况（1997 年至 2008 年）。对数据进行加权处理，以计算随时间推移的全国阿片类药物处方的估计值。采用 logistic 回归分析，对复杂调查设计进行调整，以确定与阿片类药物使用相关的因素。
慢性腹痛的门诊就诊人数持续下降，从 1997 年至 1999 年的 1480 万次就诊（95%置信区间 [CI]，1160 万-1800 万次）降至 2006 年至 2008 年的 1220 万次就诊（95% CI，900 万-1560 万次）或每 10 万人中 1863 次就诊（趋势 P=0.04）。相反，调整后开具阿片类药物处方的就诊比例从 1997 年至 1999 年的 5.9%（95% CI，3.5%-8.3%）增加到 2006 年至 2008 年的 12.2%（95% CI，7.5%-17.0%）（趋势 P=0.03）。25 岁至 40 岁的患者开具阿片类药物处方的比例最高（优势比 [OR] 4.6；95% CI，1.2-18.4）。无保险（OR 0.1；95% CI，0.04-0.40）和非裔美国人（OR 0.3；95% CI，0.1-0.9）患者开具阿片类药物处方的比例较低。
从 1997 年到 2008 年，治疗慢性腹痛的阿片类药物处方增加了一倍多。需要进一步研究以更好地了解这一趋势的原因和后果。
