Ferrari Renata, Zanolin Maria E, Duse Genni, Visentin Marco
Pain Pract. 2015 Mar;15(3):272-8. doi: 10.1111/papr.12176.
There is general agreement about the need to perform a screening test to assess the risk of opioid misuse prior to starting a long-term opioid treatment for chronic noncancer pain. The evidence supporting the effectiveness of opioid long-term treatment is weak, and no predictors of its usefulness have been assessed.
The aim of this study was to assess the effect on pain and quality of life of chronic opioid treatment, and detect the possible predictors of its effectiveness.
This observational, prospective study was conducted in 2 Italian Pain Relief Units on 77 patients affected by intractable chronic pain. Patients were submitted to psycho-logical tests, investigating the individual pain experience, risk of opioid misuse, mood states, quality of life, and personality characteristics prior to starting treatment and at 2,4, and 6-month follow-up.
Both maximum and habitual pain, as measured with VAS, underwent a statistically significant reduction at 2, 4, and 6-month follow-up. In multivariate analysis, lower scores in the Pain Medication Questionnaire (PMQ) were predictive of a major reduction in maximum VAS (P = 0.005). Both low PMQ and MMPI-cynicism scores were predictive of habitual VAS decrease (P = 0.012 and P = 0.028, respectively).
The results indicate that pain relief significantly improved over a 6-month period of opioid treatment, together with quality of life. The outcome was better in patients with a pretreatment low risk of opioid misuse, low scores in the Cynicism scale of MMPI-2, and no aberrant drug behaviors at follow-up. Therefore, a psychological screening and support is crucial for a good outcome of opioid therapy for chronic noncancer pain patients.
在开始针对慢性非癌性疼痛的长期阿片类药物治疗之前，需要进行筛查测试以评估阿片类药物滥用风险，这一点已达成普遍共识。支持阿片类药物长期治疗有效性的证据不足，且尚未评估其有效性的预测因素。
本研究旨在评估慢性阿片类药物治疗对疼痛和生活质量的影响，并检测其有效性的可能预测因素。
这项观察性前瞻性研究在意大利的2个疼痛缓解单元对77例顽固性慢性疼痛患者进行。在开始治疗前以及随访的2个月、4个月和6个月时，患者接受心理测试，调查个体疼痛体验、阿片类药物滥用风险、情绪状态、生活质量和人格特征。
用视觉模拟评分法（VAS）测量的最大疼痛和习惯性疼痛在随访的2个月、4个月和6个月时均有统计学显著降低。多变量分析中，疼痛药物问卷（PMQ）得分较低预示着最大VAS有较大幅度降低（P = 0.005）。低PMQ得分和明尼苏达多相人格调查表（MMPI）-犬儒主义得分均预示着习惯性VAS降低（分别为P = 0.012和P = 0.028）。
结果表明，在6个月的阿片类药物治疗期间，疼痛缓解以及生活质量均有显著改善。阿片类药物滥用预处理风险低、MMPI-2犬儒主义量表得分低且随访时无异常药物行为的患者结局更好。因此，心理筛查和支持对于慢性非癌性疼痛患者阿片类药物治疗的良好结局至关重要。
