Centre for Applied Research in Mental Health and Addictions (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; 3Social and Epidemiological Research.
Pain Physician. 2013 Nov-Dec;16(6):E671-84.
Prescription opioid analgesics (POA) are widely used in the pharmacotherapeutic treatment of acute and chronic pain in North America, where nonmedical prescription opioid use (NMPOU) has become a substantial public health concern in recent years. Existing epidemiological data suggest an association between NMPOU and pain problem symptoms in different populations, including samples in substance use treatment, although the extent of these correlations has not been systematically assessed.
To systematically review and meta-analyze the prevalence of pain symptoms or problems among populations reporting NMPOU in substance use treatment.
Systematic review and meta-analyses.
A systematic review and meta-analyses were conducted for pain symptoms in substance use treatment samples reporting NMPOU within the last 30 days or at admission to treatment. Overall, 8 unique epidemiological studies were identified and included in the meta-analyses; in 7 of these samples POAs were the primary drug and/or POA dependence was reported.
The pooled prevalence of pain in all NMPOU samples in substance use treatment was 58% (95% confidence interval [CI]: 53%-64%). The pooled prevalence of pain in the studies with POAs as the primary drug and/or POA dependence was 60% (95% CI: 52%-67%), and the prevalence of pain with "any" POA abuse (n = 2 studies) was 50% (95% CI: 40%-60%).
A small number of studies were available and included in the review; these were restricted to cross-sectional datasets only. Statistical heterogeneity was found in the meta-analytical results.
Pain symptoms are disproportionately elevated in substance use treatment samples reporting NMPOU. Effective measures to prevent and treat NMPOU are urgently needed, although a substantive extent of NMPOU observed in this specific context may relate directly or indirectly to the presence of pain, e.g., either as an expression of ineffective pain care or as a consequence of previous POA-based interventions. At the same time, effective ways to treat and address ongoing pain issues in NMPOU samples need to be implemented, which may require ongoing opioid-based pharmacotherapeutic care aimed at both pain and dependence.
处方类阿片类镇痛药（POA）广泛应用于北美的急性和慢性疼痛的药物治疗中，近年来，非医疗目的使用处方类阿片（NMPOU）已成为一个严重的公共卫生问题。现有的流行病学数据表明，NMPOU 与不同人群的疼痛问题症状之间存在关联，包括药物使用治疗样本，但这些相关性的程度尚未系统评估。
系统回顾和荟萃分析报告在药物使用治疗中 NMPOU 的人群的疼痛症状流行率。
系统回顾和荟萃分析。
对报告过去 30 天内或治疗入院时 NMPOU 的药物使用治疗样本中的疼痛症状进行系统回顾和荟萃分析。总共确定了 8 项独特的流行病学研究，并将其纳入荟萃分析；其中 7 项样本中 POA 是主要药物，或报告 POA 依赖。
在所有药物使用治疗中的 NMPOU 样本中，疼痛的总体流行率为 58%（95%置信区间[CI]：53%-64%）。以 POA 为主要药物和/或 POA 依赖的研究中疼痛的流行率为 60%（95%CI：52%-67%），而“任何”POA 滥用的疼痛流行率为 50%（95%CI：40%-60%）。
研究数量有限，且纳入的研究均为横断面数据集。荟萃分析结果存在统计学异质性。
报告 NMPOU 的药物使用治疗样本中，疼痛症状明显升高。迫切需要采取有效措施来预防和治疗 NMPOU，尽管在这种特定背景下观察到的大量 NMPOU 可能直接或间接与疼痛有关，例如，表现为无效的疼痛护理，或者是由于之前的 POA 干预。同时，需要实施针对 NMPOU 样本中持续疼痛问题的有效治疗和处理方法，这可能需要持续的基于阿片类药物的治疗，以同时解决疼痛和依赖问题。
