Morasco Benjamin J, Yarborough Bobbi Jo, Smith Ning X, Dobscha Steven K, Deyo Richard A, Perrin Nancy A, Green Carla A
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
J Pain. 2017 Apr;18(4):437-445. doi: 10.1016/j.jpain.2016.12.004. Epub 2016 Dec 18.
Some previous research has examined pain-related variables on the basis of prescription opioid dose, but data from studies involving patient-reported outcomes have been limited. This study examined the relationships between prescription opioid dose and self-reported pain intensity, function, quality of life, and mental health. Participants were recruited from 2 large integrated health systems, Kaiser Permanente Northwest (n = 331) and VA Portland Health Care System (n = 186). To be included, participants had to have musculoskeletal pain diagnoses and be receiving stable doses of long-term opioid therapy. We divided participants into 3 groups on the basis of current prescription opioid dose in daily morphine equivalent dose (MED): low dose (5-20 mg MED), moderate dose (20.1-50 mg MED), and higher dose (50.1-120 mg MED) groups. A statistically significant trend emerged where higher prescription opioid dose was associated with moderately sized effects including greater pain intensity, more impairments in functioning and quality of life, poorer self-efficacy for managing pain, greater fear avoidance, and more health care utilization. Rates of potential alcohol and substance use disorders also differed among groups. Findings from this evaluation reveal significant differences in pain-related and substance-related factors on the basis of prescription opioid dose.
This study included 517 patients who were prescribed long-term opioid therapy and compared differences on pain- and mental health-related variables on the basis of prescription opioid dose. Findings reveal small- to medium-sized differences on pain-related variables, alcohol and substance use, and health care utilization on the basis of the dose of opioid prescribed.
一些先前的研究已根据处方阿片类药物剂量研究了与疼痛相关的变量，但涉及患者报告结局的研究数据有限。本研究考察了处方阿片类药物剂量与自我报告的疼痛强度、功能、生活质量和心理健康之间的关系。参与者从两个大型综合医疗系统招募，即西北凯撒永久医疗集团（n = 331）和波特兰退伍军人医疗保健系统（n = 186）。要纳入研究，参与者必须有肌肉骨骼疼痛诊断且正在接受稳定剂量的长期阿片类药物治疗。我们根据每日吗啡等效剂量（MED）将参与者分为3组：低剂量组（5 - 20毫克MED）、中等剂量组（20.1 - 50毫克MED）和高剂量组（50.1 - 120毫克MED）。出现了一个具有统计学意义的趋势，即较高的处方阿片类药物剂量与中等程度的影响相关，包括更大的疼痛强度、更多的功能和生活质量受损、更差的疼痛管理自我效能、更大的恐惧回避以及更多的医疗保健利用。潜在酒精和物质使用障碍的发生率在各组之间也有所不同。该评估的结果揭示了基于处方阿片类药物剂量在疼痛相关和物质相关因素方面的显著差异。
本研究纳入了517名接受长期阿片类药物治疗的患者，并根据处方阿片类药物剂量比较了疼痛和心理健康相关变量的差异。结果显示，基于所开阿片类药物剂量，在疼痛相关变量、酒精和物质使用以及医疗保健利用方面存在中小程度的差异。
