Stein Michael D, Herman Debra S, Bailey Genie L, Straus John, Anderson Bradley J, Uebelacker Lisa A, Weisberg Risa B
Butler Hospital, Providence, Rhode Island, 345 Blackstone Boulevard, Providence, RI, 02906, USA,
J Gen Intern Med. 2015 Jul;30(7):935-41. doi: 10.1007/s11606-015-3212-y. Epub 2015 Feb 13.
Pain and depression are each prevalent among opioid dependent patients receiving maintenance buprenorphine, but their interaction has not been studied in primary care patients.
We set out to examine the relationship between chronic pain, depression, and ongoing substance use, among persons maintained on buprenorphine in primary care settings.
Between September 2012 and December 2013, we interviewed buprenorphine patients at three practice sites.
Opioid dependent persons at two private internal medicine offices and a federally qualified health center participated in the study.
Pain was measured in terms of chronicity, with chronic pain being defined as pain lasting at least 6 months; and in terms of severity, as measured by self-reported pain in the past week, measured on a 0-100 scale. We defined mild chronic pain as pain severity between 0 and 39 and lasting at least 6 months, and moderate/severe chronic pain as severity ≥ 40 and lasting at least 6 months. To assess depression, we used the Center for Epidemiologic Studies Depression (CESD) ten-item symptom scale and the two-item Patient Health Questionnaire (PHQ-2).
Among 328 participants, 169 reported no chronic pain, 56 reported mild chronic pain, and 103 reported moderate/severe chronic pain. Participants with moderate/severe chronic pain commonly used non-opioid pain medications (56.3%) and antidepressants (44.7%), yet also used marijuana, alcohol, or cocaine (40.8%) to help relieve pain. Mean CESD scores were 7.1 (±6.8), 8.3 (±6.0), and 13.6 (±7.6) in the no chronic, mild, and moderate/severe pain groups, respectively. Controlling for covariates, higher CESD scores were associated with a higher likelihood of moderate/severe chronic pain relative to both no chronic pain (OR = 1.09, p < 0.001) and mild chronic pain (OR = 1.06, p = 0.04).
Many buprenorphine patients are receiving over-the-counter or prescribed pain medications, as well as antidepressants, and yet continue to have significant and disabling pain and depressive symptoms. There is a clear need to address the pain-depression nexus in novel ways.
疼痛和抑郁在接受丁丙诺啡维持治疗的阿片类药物依赖患者中都很常见，但它们之间的相互作用在初级保健患者中尚未得到研究。
我们着手研究在初级保健环境中接受丁丙诺啡维持治疗的人群中慢性疼痛、抑郁和持续物质使用之间的关系。
在2012年9月至2013年12月期间，我们在三个医疗机构对丁丙诺啡患者进行了访谈。
两个私立内科诊所和一个联邦合格健康中心的阿片类药物依赖者参与了这项研究。
疼痛根据慢性程度进行测量，慢性疼痛定义为持续至少6个月的疼痛；并根据严重程度进行测量，通过过去一周自我报告的疼痛程度来衡量，采用0至100分制。我们将轻度慢性疼痛定义为疼痛严重程度在0至39分之间且持续至少6个月，中度/重度慢性疼痛定义为严重程度≥40分且持续至少6个月。为了评估抑郁，我们使用了流行病学研究中心抑郁（CESD）十项症状量表和两项患者健康问卷（PHQ-2）。
在328名参与者中，169人报告无慢性疼痛，56人报告轻度慢性疼痛，103人报告中度/重度慢性疼痛。中度/重度慢性疼痛的参与者通常使用非阿片类止痛药物（56.3%）和抗抑郁药物（44.7%），但也使用大麻、酒精或可卡因（40.8%）来帮助缓解疼痛。无慢性疼痛、轻度疼痛和中度/重度疼痛组的平均CESD得分分别为7.1（±6.8）、8.3（±6.0）和13.6（±7.6）。在控制协变量后，与无慢性疼痛（OR = 1.09，p < 0.001）和轻度慢性疼痛（OR = 1.06，p = 0.04）相比，较高的CESD得分与中度/重度慢性疼痛的可能性增加相关。
许多丁丙诺啡患者正在服用非处方或处方止痛药物以及抗抑郁药物，但仍继续存在严重且致残性的疼痛和抑郁症状。显然需要以新的方式解决疼痛与抑郁的关联问题。
