Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK.
Pain. 2013 Jul;154(7):1038-44. doi: 10.1016/j.pain.2013.03.011. Epub 2013 Mar 26.
Opioid prescribing for chronic noncancer pain is increasing, but there is limited knowledge about longer-term outcomes of people receiving opioids for conditions such as back pain. This study aimed to explore the relationship between prescribed opioids and disability among patients consulting in primary care with back pain. A total of 715 participants from a prospective cohort study, who gave consent for review of medical and prescribing records and completed baseline and 6month follow-up questionnaires, were included. Opioid prescription data were obtained from electronic prescribing records, and morphine equivalent doses were calculated. The primary outcome was disability (Roland-Morris Disability Questionnaire [RMDQ]) at 6months. Multivariable linear regression was used to examine the association between opioid prescription at baseline and RMDQ score at 6months. Analyses were adjusted for potential confounders using propensity scores reflecting the probability of opioid prescription given baseline characteristics. In the baseline period, 234 participants (32.7%) were prescribed opioids. In the final multivariable analysis, opioid prescription at baseline was significantly associated with higher disability at 6-month follow-up (P<.022), but the magnitude of this effect was small, with a mean RMDQ score of 1.18 (95% confidence interval: 0.17 to 2.19) points higher among those prescribed opioids compared to those who were not. Our findings indicate that even after adjusting for a substantial number of potential confounders, opioids were associated with slightly worse functioning in back pain patients at 6-month follow-up. Further research may help us to understand the mechanisms underlying these findings and inform clinical decisions regarding the usefulness of opioids for back pain.
慢性非癌性疼痛的阿片类药物处方量正在增加，但对于接受阿片类药物治疗背痛等疾病的患者的长期结局，我们知之甚少。本研究旨在探讨初级保健就诊的背痛患者中，处方阿片类药物与残疾之间的关系。共有 715 名来自前瞻性队列研究的参与者同意审查医疗和处方记录，并完成了基线和 6 个月随访问卷，包括在内。从电子处方记录中获得了阿片类药物处方数据，并计算了吗啡等效剂量。主要结局是 6 个月时的残疾（Roland-Morris 残疾问卷 [RMDQ]）。多变量线性回归用于检查基线时的阿片类药物处方与 6 个月时 RMDQ 评分之间的关系。使用反映基线特征下开具阿片类药物可能性的倾向评分来调整潜在混杂因素的分析。在基线期间，234 名参与者（32.7%）被开了阿片类药物处方。在最终的多变量分析中，基线时开具阿片类药物处方与 6 个月随访时的残疾程度显著相关（P<.022），但这种影响的程度很小，与未开具阿片类药物的患者相比，开具阿片类药物的患者的 RMDQ 评分平均高 1.18（95%置信区间：0.17 至 2.19）分。我们的研究结果表明，即使在调整了大量潜在混杂因素后，阿片类药物与背痛患者在 6 个月随访时的功能稍差相关。进一步的研究可能有助于我们了解这些发现的机制，并为阿片类药物治疗背痛的临床决策提供信息。
