Mental Health and Clinical Neurosciences Division and.
Fam Pract. 2013 Dec;30(6):671-8. doi: 10.1093/fampra/cmt038. Epub 2013 Jul 30.
There is growing interest in the primary care management of patients with chronic non-cancer pain (CNCP) who are prescribed long-term opioid therapy.
The aim of this study was to examine the care management practices and medical utilization of patients prescribed high doses of opioids relative to patients prescribed traditional doses of opioids.
We conducted a retrospective cohort study of veterans who had CNCP in 2008 and reviewed medical care for the prior 2 years. Patients with CNCP who were prescribed high-dose opioid therapy (≥180mg morphine equivalent per day for 90+ consecutive days; n = 60) were compared with patients prescribed traditional dose opioid therapy (5-179mg morphine equivalent per day for 90+ consecutive days; n = 60).
Patients in the high-dose group had several aspects of documented care that differed from patients in the traditional dose group, including more medical visits, attempting an opioid taper, receiving a urine drug screen and developing a pain goal. The majority of variables that were assessed did not differ between groups, including documented assessments of functional status or co-morbid psychopathology, opioid rotation, discussion of treatment side effects, non-pharmacological treatments or collaboration with mental health or pain specialists.
Further work is needed to identify mechanisms for optimizing care management for patients with CNCP who are prescribed high doses of opioid medications.
对于接受长期阿片类药物治疗的慢性非癌性疼痛（CNCP）患者的初级保健管理，人们越来越感兴趣。
本研究旨在检查开具高剂量阿片类药物的患者与开具传统剂量阿片类药物的患者的护理管理实践和医疗利用情况。
我们对 2008 年患有 CNCP 的退伍军人进行了回顾性队列研究，并回顾了他们之前 2 年的医疗护理情况。将接受高剂量阿片类药物治疗（≥180mg 吗啡当量/天，连续 90 天以上；n=60）的 CNCP 患者与接受传统剂量阿片类药物治疗（5-179mg 吗啡当量/天，连续 90 天以上；n=60）的患者进行比较。
高剂量组的患者在记录的护理方面有几个方面与传统剂量组的患者不同，包括更多的医疗就诊、尝试阿片类药物减量、接受尿液药物检测和制定疼痛目标。评估的大多数变量在两组之间没有差异，包括记录的功能状态或合并精神病理学评估、阿片类药物转换、治疗副作用讨论、非药物治疗或与心理健康或疼痛专家合作。
需要进一步研究，以确定优化接受高剂量阿片类药物治疗的 CNCP 患者护理管理的机制。
