Robinson James P, Dansie Elizabeth J, Wilson Hilary D, Rapp Suzanne, Turk Dennis C
Department of Rehabilitation Medicine, Outcomes Research, Bethesda, Maryland.
Evidera, Outcomes Research, Seattle, Washington.
Pain Med. 2015 Jul;16(7):1311-24. doi: 10.1111/pme.12770. Epub 2015 Apr 30.
This study was designed to gain insight into the apparent contradiction between the perspectives of researchers and policy makers, who have questioned the efficacy and safety of chronic opioid therapy for non-cancer pain patients, and the patients themselves, who often indicate that the therapy has value.
A convenience sample of 54 patients on chronic opioid therapy was studied.
Participants completed a questionnaire specifically designed for the study, and also several standard instruments that addressed functional interference, emotional functioning, and possible misuse of opioids. Their treating physicians rated the participants on the severity of their disability and the success of their opioid therapy.
Although participants reported significant ongoing pain, they gave positive global ratings to their opioid therapy, and reported little concern about addiction or side effects of opioids. They strongly endorsed the beliefs that opioids helped them control their pain and allowed them to participate in important activities such as work. They expressed the belief that their pain would be severe if they did not have access to opioids, and reported negative experiences with tapering or discontinuing opioids in the past. Work-disabled participants reported higher levels of affective distress, catastrophizing, and functional interference than working participants, and were judged by their physicians to be relatively less successful in managing their pain.
The results of this study suggest several tentative hypotheses about why patients on chronic opioid therapy value opioids, and identified several areas for systematic investigation in the future.
本研究旨在深入了解研究人员和政策制定者与患者自身观点之间明显的矛盾之处。研究人员和政策制定者质疑慢性阿片类药物疗法对非癌症疼痛患者的疗效和安全性，而患者自己却常常表示该疗法有价值。
对54名接受慢性阿片类药物治疗的患者进行了便利抽样研究。
参与者完成了一份专门为该研究设计的问卷，以及几份涉及功能干扰、情绪功能和阿片类药物可能滥用情况的标准量表。他们的主治医生对参与者的残疾严重程度和阿片类药物治疗的成效进行了评分。
尽管参与者报告仍有明显疼痛，但他们对阿片类药物治疗给予了积极的总体评价，并且表示对阿片类药物成瘾或副作用几乎没有担忧。他们强烈认同阿片类药物有助于他们控制疼痛并使他们能够参与诸如工作等重要活动的观点。他们表示认为如果无法使用阿片类药物，他们的疼痛会很严重，并且报告了过去在逐渐减少或停用阿片类药物时的负面经历。与有工作的参与者相比，因工作残疾的参与者报告了更高水平的情感困扰、灾难化思维和功能干扰，并且他们的医生认为他们在控制疼痛方面相对不太成功。
本研究结果提出了几个关于接受慢性阿片类药物治疗的患者为何重视阿片类药物的初步假设，并确定了未来需要系统研究的几个领域。
