Barth Kelly S, Balliet Wendy, Pelic Christine M, Madan Alok, Malcolm Robert, Adams David, Morgan Katherine, Owczarski Stefanie, Borckardt Jeffrey J
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Pain Med. 2014 Aug;15(8):1359-64. doi: 10.1111/pme.12403. Epub 2014 Apr 9.
The objective of this study is to assess clinical variables that may be associated with risk for opioid misuse in individuals with chronic pancreatitis.
This study utilized a descriptive, quasi-experimental, cross sectional design.
Three hundred seven individuals with nonalcoholic chronic pancreatitis engaged in chronic opioid therapy for pain presented to an outpatient specialty clinic at an academic medical center.
Participants completed the Current Opioid Misuse Measure (COMM), Brief Pain Inventory (BPI), Short Form (SF)-12 Quality of Life Measure, Center for Epidemiological Studies 10-item Depression Scale (CESD), and a single item asking about current alcohol use. Mean scores on the CESD, COMM, BPI, SF-12, and factors associated with opioid misuse measures from regression analyses were the outcome measures.
Mean scores on the CESD, COMM, BPI pain-on-average item, and the SF-12 physical and psychological quality of life factors (t scores) were 11.2 (standard deviation [SD] = 6.7), 8.5 (SD = 7.3), 4.8 (SD = 2.8), 39.7 (SD = 7.0), and 45 (SD = 9.0), respectively. Descriptive analyses revealed that 55% of participants scored above the clinical cutoff for depression on the CESD, and 39% scored above the cutoff for opioid misuse concerns on the COMM. Regression analyses identified several factors associated with higher opioid misuse measure scores, including increased depressive symptoms from the CESD (β = 0.38, P < 0.0001), increased pain rating at the time of the office visit (β = 0.16, P = 0.03), impairment of psychological quality of life (β = -0.27, P = 0.001) and endorsement of alcohol use (β = 0.16, P = 0.03). These factors accounted for 37% of the variance in current opioid misuse scores.
Depression, quality of life, pain intensity and alcohol use may be good candidate variables for prospective studies to determine clinical risk factors for opioid misuse among patients with pancreatitis.
本研究的目的是评估可能与慢性胰腺炎患者阿片类药物滥用风险相关的临床变量。
本研究采用描述性、准实验性横断面设计。
307名因疼痛接受慢性阿片类药物治疗的非酒精性慢性胰腺炎患者前往一家学术医疗中心的门诊专科诊所就诊。
参与者完成了当前阿片类药物滥用量表（COMM）、简明疼痛量表（BPI）、简短健康调查问卷（SF）-12生活质量量表、流行病学研究中心10项抑郁量表（CESD），以及一个关于当前饮酒情况的单项问题。CESD、COMM、BPI、SF-12的平均得分以及回归分析中与阿片类药物滥用测量相关的因素为结果指标。
CESD、COMM、BPI平均疼痛项目以及SF-12身体和心理生活质量因素（t分数）的平均得分分别为11.2（标准差[SD]=6.7）、8.5（SD=7.3）、4.8（SD=2.8）、39.7（SD=7.0）和45（SD=9.0）。描述性分析显示，55%的参与者在CESD上的得分高于抑郁症临床临界值，39%的参与者在COMM上的得分高于阿片类药物滥用担忧临界值。回归分析确定了几个与阿片类药物滥用测量得分较高相关的因素，包括CESD中抑郁症状增加（β=0.38，P<0.0001）、就诊时疼痛评分增加（β=0.16，P=0.03）、心理生活质量受损（β=-0.27，P=0.001）以及饮酒认可（β=0.16，P=0.03）。这些因素占当前阿片类药物滥用得分方差的37%。
抑郁、生活质量、疼痛强度和饮酒情况可能是前瞻性研究中确定胰腺炎患者阿片类药物滥用临床风险因素的良好候选变量。
