Bostick Geoff P, Toth Cory, Carr Eloise C J, Stitt Larry W, Morley-Forster Patricia, Clark Alexander J, Lynch Mary, Gordon Allan, Nathan Howard, Smyth Catherine, Ware Mark A, Moulin Dwight E
Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
Fraser Valley Health Authority, Burnaby, Canada.
Pain Med. 2015 Jul;16(7):1361-8. doi: 10.1111/pme.12702. Epub 2015 Feb 3.
To evaluate the association between opioid dosage and ongoing therapy with physical function and disability in patients with neuropathic pain (NeP).
Secondary analysis of a prospective cohort.
Multicenter clinical NeP registry.
Seven hundred eighty-nine patients treated for various NeP diagnoses.
The following measures were included: dependent variables. 12-month self-reported physical function (pain disability index [PDI] and medical outcomes study short form-12 physical function [PCSS-12]); independent variables: baseline opioid dose (none, ≤200 mg and >200 mg of morphine equivalent), ongoing opioid use; potential confounding variables: age, sex, baseline pain intensity, and psychological distress (profile of mood states). Analysis of covariance models was created to examine the relationship between opioid therapy and both physical functioning outcomes with adjustment for confounding.
Complete data was available for 535 patients (68%). Compared with the lower and high dose opioid groups, NeP patients not taking opioids had statistically lower disability and higher physical functioning scores, after adjusting for disease severity. Compared with patients prescribed opioid therapy on an ongoing basis, NeP patients who were not prescribed had statistically lower disability and higher physical functioning scores, after adjusting for disease severity. Improvements in disability and physical functioning scores from baseline and 12-months in all groups were modest and may not be clinically significant.
Physical functioning and disability did not improve in patients with NeP who were prescribed opioids compared with those who are not prescribed, even after adjusting for disease severity.
评估阿片类药物剂量与神经性疼痛（NeP）患者持续治疗对身体功能和残疾的关联。
前瞻性队列的二次分析。
多中心临床NeP登记处。
789例因各种NeP诊断接受治疗的患者。
纳入以下测量指标：因变量。12个月自我报告的身体功能（疼痛残疾指数[PDI]和医学结局研究简表-12身体功能[PCSS-12]）；自变量：基线阿片类药物剂量（无、≤200毫克和>200毫克吗啡当量）、持续使用阿片类药物；潜在混杂变量：年龄、性别、基线疼痛强度和心理困扰（情绪状态剖面图）。建立协方差分析模型以检验阿片类药物治疗与身体功能结局之间的关系，并对混杂因素进行校正。
535例患者（68%）有完整数据。调整疾病严重程度后，与低剂量和高剂量阿片类药物组相比，未服用阿片类药物的NeP患者残疾程度在统计学上更低，身体功能得分更高。调整疾病严重程度后，与持续接受阿片类药物治疗的患者相比，未接受阿片类药物治疗的NeP患者残疾程度在统计学上更低，身体功能得分更高。所有组从基线到12个月残疾和身体功能得分的改善均较小，可能无临床意义。
与未服用阿片类药物的患者相比，即使调整疾病严重程度，服用阿片类药物的NeP患者的身体功能和残疾情况并未改善。
