Lin Tso-Chou, Ger Luo-Ping, Pergolizzi Joseph V, Raffa Robert B, Wang Ju-O, Ho Shung-Tai
Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
J Formos Med Assoc. 2017 Apr;116(4):257-265. doi: 10.1016/j.jfma.2016.10.015. Epub 2016 Dec 23.
BACKGROUND/PURPOSE: Prescribing opioids for chronic noncancer pain has been strictly regulated for two decades in Taiwan. The aim of this study was to survey the patients' perspectives and potential drawbacks following long-term use of opioids.
An observational cross-sectional survey using the Taiwanese version of Brief Pain Inventory was conducted among outpatients with chronic noncancer pain registered by the Taiwan Food and Drug Administration. Patients were also asked about their sexual behavior, depression, opioid misuse behaviors, and use of complementary and alternative medicine.
For 210 of 328 outpatients (64.0%), the median pain duration was 96 months and opioid treatment duration was 57 months. The median morphine equivalent dose was 150 mg/d, with 30.5% of patients exceeding the daily watchful dose, defined as 200 mg of morphine equivalent dose. Pain reduction after taking opioids was ∼50% in the past week. The top three diagnoses were chronic pancreatitis, spinal cord injury, and neuralgia. The leading side effects were constipation (46.7%), and decreased sexual desire (69.5%) and satisfaction (57.9%). Depression was currently diagnosed in 55.2% of patients. Twenty patients (9.5%) displayed at least one aberrant behavior in the past month. Only 76 (36.2%) patients had ever received nerve block procedures, and 118 (56.2%) tried complementary and alternative medicine.
This nationwide survey described the concurrent pain intensity, daily function, and various adverse effects by long-term opioids among 210 monitored outpatients with chronic noncancer pain in Taiwan. More efforts are suggested to reduce opioid prescriptions in the 30% of patients exceeding daily watchful dose.
背景/目的：在台湾，开具阿片类药物用于慢性非癌性疼痛已有二十年受到严格监管。本研究的目的是调查患者对长期使用阿片类药物的看法及潜在弊端。
采用台湾版简明疼痛量表对台湾食品药品管理局登记的慢性非癌性疼痛门诊患者进行观察性横断面调查。患者还被问及他们的性行为、抑郁情况、阿片类药物滥用行为以及补充和替代医学的使用情况。
328名门诊患者中的210名（64.0%），疼痛持续时间中位数为96个月，阿片类药物治疗持续时间为57个月。吗啡等效剂量中位数为150毫克/天，30.5%的患者超过每日警戒剂量，该剂量定义为200毫克吗啡等效剂量。在过去一周内服用阿片类药物后疼痛减轻约50%。前三大诊断为慢性胰腺炎、脊髓损伤和神经痛。主要副作用为便秘（46.7%）、性欲减退（69.5%）和满意度降低（57.9%）。目前55.2%的患者被诊断为抑郁症。20名患者（9.5%）在过去一个月内表现出至少一种异常行为。只有76名（36.2%）患者曾接受过神经阻滞手术，118名（56.2%）患者尝试过补充和替代医学。
这项全国性调查描述了台湾210名接受监测的慢性非癌性疼痛门诊患者长期使用阿片类药物时的疼痛强度、日常功能及各种不良反应。建议加大力度减少30%超过每日警戒剂量患者的阿片类药物处方。
