Cleveland Clinic Neurological Center for Pain, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
Pain Med. 2013 Dec;14(12):1908-17. doi: 10.1111/pme.12201. Epub 2013 Aug 5.
To examine the frequency of and factors predicting opioid resumption among patients with chronic non-cancer pain (CNCP) and therapeutic opioid addiction (TOA) treated in an interdisciplinary chronic pain rehabilitation program (CPRP) incorporating opioid weaning.
Longitudinal retrospective treatment outcome study. Only those with addiction were counseled to avoid opioids for non-acute pain.
Large academic medical center.
One hundred twenty patients, 32.5% with TOA. Participants were predominately married (77.5%), females (66.7%). Mean age was 49.5 (±13.7). 29.2% had lifetime histories of non-opioid substance use disorders.
TOA was diagnosed using consensus definitions developed by American Academy of Pain Medicine, American Pain Society and American Society of Addiction Medicine to supplement Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) criteria. Non-opioid substance use disorders were diagnosed using DSM-IV-TR. Data, including pain severity, depression and anxiety, were collected at admission, discharge and 12 months. Opioid use during treatment was based on medical records and use at 12 months was based on self-report.
Only 22.5% reported resuming use at 12 months. Neither patients with TOA nor patients with non-opioid substance use disorders were more likely to resume use than those without substance use disorders. Only posttreatment depression increased the probability of resumption.
CNCP and co-occurring TOA can be successfully treated within a CPRP. Patients report low rates of resumption regardless of addiction status. This is in marked contrast to reported outcomes of non-medically induced opioid addictions. Prolonged abstinence may depend upon the successful treatment of depression.
调查接受包含阿片类药物逐渐减量的多学科慢性疼痛康复治疗计划（CPRP）治疗的慢性非癌性疼痛（CNCP）和治疗性阿片类药物成瘾（TOA）患者的阿片类药物再使用频率及相关预测因素。
纵向回顾性治疗结果研究。仅对有阿片类药物成瘾的患者进行避免将阿片类药物用于非急性疼痛的咨询。
大型学术医疗中心。
120 名患者，其中 32.5%为 TOA 患者。参与者主要为已婚（77.5%），女性（66.7%）。平均年龄为 49.5（±13.7）岁。29.2%有终生非阿片类物质使用障碍史。
TOA 的诊断采用美国疼痛医学学院、美国疼痛协会和美国药物滥用医学会制定的共识定义来补充《精神障碍诊断与统计手册》第 4 版修订本（DSM-IV-TR）标准。非阿片类物质使用障碍的诊断采用 DSM-IV-TR。数据包括疼痛严重程度、抑郁和焦虑，在入院时、出院时和 12 个月时收集。治疗期间的阿片类药物使用情况基于医疗记录，12 个月时的使用情况基于自我报告。
只有 22.5%的患者报告在 12 个月时恢复使用。无论是 TOA 患者还是非阿片类物质使用障碍患者，其恢复使用的可能性均不比无物质使用障碍的患者高。只有治疗后抑郁增加了恢复使用的可能性。
CPRP 可成功治疗 CNCP 和共存的 TOA。无论成瘾状态如何，患者报告的再使用率都较低。这与非医学诱导的阿片类药物成瘾的报告结果形成鲜明对比。长期禁欲可能取决于抑郁的有效治疗。
