Center for Health Care Evaluation, Department of Veterans Affairs, Menlo Park, California 94025, USA.
Pain Med. 2012 Apr;13(4):507-17. doi: 10.1111/j.1526-4637.2012.01352.x.
The objective of this study was to explore the relationship between patterns of opioid use, pain severity, and pain-related mental health in chronic pain patients prescribed opioids.
The study was designed as a one-time patient interview with structured pain and opioid use assessments.
The study was set in a tertiary care medical center in the United States Department of Veterans Affairs. PATIENTS. Study participants were primary care patients with a pain condition for greater than 6 months who received at least one prescription for an opioid in the prior 12 months.
The Prescription Drug Use Questionnaire was used to assess patterns of opioid use. The Pain Outcomes Questionnaire was used to assess pain-related functioning.
Symptomatic use of opioid medication (e.g., taking an opioid in response to increased pain) was more common than scheduled (i.e., taking an opioid at regular times) or strategic use of opioid medication (e.g., taking an opioid specifically to engage in activities). Symptomatic use of opioids was associated with poorer pain-related mental health, after controlling for pain duration and pain-related physical functioning. Use of opioids in a scheduled pattern was associated with better pain-related mental health. Patients rarely reported that they used opioids strategically to facilitate functional activities.
The patterns in which patients use their opioid medications are associated with their psychological functioning. This is consistent with theory regarding the potential impact of reinforcing effects of opioid medication on functional outcomes. Interventions to encourage strategic or scheduled opioid use warrant investigation as methods to improve pain outcomes with opioids.
本研究旨在探讨慢性疼痛患者阿片类药物使用模式、疼痛严重程度和与疼痛相关的心理健康之间的关系。
本研究设计为一次性患者访谈，采用结构化疼痛和阿片类药物使用评估。
本研究在美国退伍军人事务部的一家三级护理医疗中心进行。
研究参与者为慢性疼痛超过 6 个月且在过去 12 个月内至少有一次阿片类药物处方的初级保健患者。
使用处方药物使用问卷评估阿片类药物使用模式。使用疼痛结局问卷评估与疼痛相关的功能。
阿片类药物的症状性使用（例如，在疼痛加重时服用阿片类药物）比计划性（即按时服用阿片类药物）或策略性使用阿片类药物（例如，专门服用阿片类药物以参与活动）更为常见。在控制疼痛持续时间和与疼痛相关的身体功能后，阿片类药物的症状性使用与较差的与疼痛相关的心理健康相关。有规律地使用阿片类药物与更好的与疼痛相关的心理健康相关。患者很少报告他们有策略地使用阿片类药物来促进功能活动。
患者使用阿片类药物的模式与其心理功能有关。这与关于阿片类药物的强化作用对功能结果的潜在影响的理论一致。鼓励有策略或有规律地使用阿片类药物的干预措施值得研究，以改善阿片类药物治疗疼痛的效果。
