Thielke Stephen M, Shortreed Susan M, Saunders Kathleen, Turner Judith A, LeResche Linda, Von Korff Michael
Departments of *Psychiatry and Behavioral Sciences ∥Rehabilitation Medicine ¶Anesthesiology and Pain Medicine §Biostatistics #Oral Medicine, University of Washington †Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center ‡Group Health Research Institute, Seattle, WA.
Clin J Pain. 2017 Mar;33(3):198-204. doi: 10.1097/AJP.0000000000000409.
Chronic pain patients at increased risk of unfavorable pain and opioid misuse outcomes may be those most likely to use opioids long-term, but this has not been evaluated prospectively.
To ascertain whether pain prognostic risk, problem opioid use risk, and depression predict opioid use 1 year later among patients recently initiating opioid therapy with a moderate likelihood of long-term opioid use.
Self-report and electronic health record data were collected from patients aged 45+ years who recently initiated opioid therapy (N=762), in an integrated health care system. Logistic regression models tested whether baseline patient chronic pain prognostic risk, problem opioid use risk, depression, and expectations concerning continued opioid use independently predicted continuing use at 1 year (≥30 d supply in the prior 4 mo).
At 1 year, 46% of participants continued to use opioids. Baseline problem opioid use risk score (adjusted odds ratio, 1.15; 95% confidence interval, 1.04-1.26) and expectations about continuing opioid use, but not pain prognostic risk score or depression, were significant predictors of 1-year opioid use. Compared with patients who thought continued opioid use unlikely, those who thought it was extremely or very likely had 4 times the odds of opioid use at 1 year (adjusted odds ratio, 4.05; 95% confidence interval, 2.59-6.31).
The strongest predictors of long-term opioid use were not patient-related or medication-related factors, but expectations about using opioids in the future. Asking about such expectations may be the easiest way to identify patients likely to continue opioid use long-term.
慢性疼痛患者出现不良疼痛和阿片类药物滥用后果的风险增加，可能是最有可能长期使用阿片类药物的人群，但这一点尚未得到前瞻性评估。
确定疼痛预后风险、问题阿片类药物使用风险和抑郁是否能预测近期开始阿片类药物治疗且长期使用阿片类药物可能性中等的患者1年后的阿片类药物使用情况。
在一个综合医疗保健系统中，收集了年龄在45岁及以上、近期开始阿片类药物治疗的患者（N = 762）的自我报告和电子健康记录数据。逻辑回归模型测试了基线患者慢性疼痛预后风险、问题阿片类药物使用风险、抑郁以及对持续使用阿片类药物的期望是否能独立预测1年后的持续使用情况（前4个月供应≥30天）。
1年后，46%的参与者继续使用阿片类药物。基线问题阿片类药物使用风险评分（调整后的优势比，1.15；95%置信区间，1.04 - 1.26）以及对持续使用阿片类药物的期望，而非疼痛预后风险评分或抑郁，是1年阿片类药物使用的显著预测因素。与认为持续使用阿片类药物不太可能的患者相比，那些认为极有可能或很有可能的患者在1年时使用阿片类药物的几率是其4倍（调整后的优势比，4.05；95%置信区间，2.59 - 6.31）。
长期使用阿片类药物的最强预测因素不是与患者相关或与药物相关的因素，而是对未来使用阿片类药物的期望。询问此类期望可能是识别可能长期持续使用阿片类药物患者的最简单方法。
