Ekholm Ola, Kurita Geana Paula, Hjsted Jette, Juel Knud, Sjgren Per
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Multidisciplinary Pain Centre, Department of Neuroanaesthesiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark Section of Palliative Medicine, Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark.
Pain. 2014 Dec;155(12):2486-2490. doi: 10.1016/j.pain.2014.07.006. Epub 2014 Jul 11.
This study aimed to investigate the risk of death, development of cancer, and hospital inpatient admissions resulting from injuries and toxicity/poisoning among opioid users with chronic noncancer pain. A population-based cohort of 13,127 adults, who have participated in the Danish Health Interview Surveys in 2000 or 2005 and have been followed up prospectively by registers until the end of 2011, were classified according to the absence or presence of chronic pain (ie, pain lasting ⩾ 6 months) and long-term or short-term opioid use (individuals using at least 1 prescription per month for 6 months in the previous year and at least 1 prescription in the previous year, respectively). The risk of all-cause mortality was 1.72 (95% confidence interval [CI]=1.23-2.41) times higher among long-term opioid users than among individuals without chronic pain. The risk of death was lower, but still significantly higher in short-term (1.36, 95% CI=1.07-1.72) and non-opioid users with chronic pain (1.39, 95% CI=1.22-1.59) than in the background population. There was no statistically significant association between long-term opioid use and cardiovascular and cancer mortality. No deaths among opioid users were caused by accidents or suicides, although opioid users had higher risks of injuries and toxicity/poisoning resulting in hospital inpatient admissions than individuals without chronic pain. The risk of all-cause mortality was significantly higher among long-term opioid users, but no obvious associations between long-term opioid use and cause-specific mortality were observed. However, opioid use increased the risk of injuries and toxicity/poisoning resulting in hospital inpatient admissions.
本研究旨在调查慢性非癌性疼痛的阿片类药物使用者因伤害以及中毒/药物过量导致的死亡风险、癌症发生情况和住院情况。对13127名成年人进行了一项基于人群的队列研究，这些人参加了2000年或2005年的丹麦健康访谈调查，并通过登记系统进行前瞻性随访直至2011年底。根据是否存在慢性疼痛（即疼痛持续时间≥6个月）以及长期或短期使用阿片类药物（分别为前一年每月至少使用1次处方持续6个月以及前一年至少使用1次处方）进行分类。长期使用阿片类药物的人群全因死亡率比无慢性疼痛的人群高1.72倍（95%置信区间[CI]=1.23 - 2.41）。短期使用阿片类药物的人群（1.36，95%CI=1.07 - 1.72）以及患有慢性疼痛的非阿片类药物使用者（1.39，95%CI=1.22 - 1.59）的死亡风险低于长期使用阿片类药物的人群，但仍显著高于背景人群。长期使用阿片类药物与心血管疾病和癌症死亡率之间无统计学显著关联。阿片类药物使用者中没有因事故或自杀导致的死亡，尽管阿片类药物使用者因伤害以及中毒/药物过量导致住院的风险高于无慢性疼痛的人群。长期使用阿片类药物的人群全因死亡率显著更高，但未观察到长期使用阿片类药物与特定病因死亡率之间存在明显关联。然而，使用阿片类药物会增加因伤害以及中毒/药物过量导致住院的风险。
