Hser Yih-Ing, Mooney Larissa J, Saxon Andrew J, Miotto Karen, Bell Douglas S, Huang David
University of California, Los Angeles, United States.
University of California, Los Angeles, United States.
J Subst Abuse Treat. 2017 Jun;77:26-30. doi: 10.1016/j.jsat.2017.03.006. Epub 2017 Mar 9.
To examine the prevalence of comorbid chronic pain among patients with opioid use disorder (OUD) and to compare other comorbidities (substance use disorder (SUD), mental health disorders, health/disease conditions) among patients in four categories: no chronic pain (No Pain), OUD prior to pain (OUD First), OUD and pain at the same time (Same Time), or pain condition prior to OUD (Pain First).
Using an electronic health record (EHR) database from 2006-2015, the study assessed 5307 adult patients with OUD in a large healthcare system; 35.6% were No Pain, 9.7% were OUD First, 14.9% were Same Time, and 39.8% were Pain First.
Most OUD patients (64.4%) had chronic pain conditions, and among them 61.8% had chronic pain before their first OUD diagnosis. Other SUDs occurred more frequently among OUD First patients than among other groups in terms of alcohol (33.4% vs. 25.4% for No Pain, 20.7% for Same Time, and 20.3% for Pain First), cocaine (19.0%, vs. 13.8%, 9.4%, 7.1%), and alcohol or drug-induced disorders. OUD First patients also had the highest rates of HIV (4.7%) and hepatitis C virus (HCV; 28.2%) among the four groups. Pain First patients had the highest rates of mental disorder (81.7%), heart disease (72.0%), respiratory disease (68.4%), sleep disorder (41.8%), cancer (23.4%), and diabetes (19.3%).
The alarming high rates of chronic pain conditions occurring before OUD and the associated severe mental health and physical health conditions require better models of assessment and coordinated care plans to address these complex medical conditions.
研究阿片类药物使用障碍（OUD）患者中慢性疼痛共病的患病率，并比较四类患者中的其他共病情况（物质使用障碍（SUD）、精神健康障碍、健康/疾病状况）：无慢性疼痛（无疼痛组）、疼痛出现前患有OUD（OUD首发组）、OUD和疼痛同时出现（同时出现组）、或OUD出现前患有疼痛状况（疼痛首发组）。
利用2006 - 2015年的电子健康记录（EHR）数据库，该研究评估了一个大型医疗系统中的5307名成年OUD患者；35.6%为无疼痛组，9.7%为OUD首发组，14.9%为同时出现组，39.8%为疼痛首发组。
大多数OUD患者（64.4%）患有慢性疼痛状况，其中61.8%在首次OUD诊断前就患有慢性疼痛。在酒精方面（OUD首发组为33.4%，无疼痛组为25.4%，同时出现组为20.7%，疼痛首发组为20.3%）、可卡因方面（19.0%，无疼痛组为13.8%，同时出现组为9.4%，疼痛首发组为7.1%）以及酒精或药物所致障碍方面，其他SUD在OUD首发组患者中比在其他组中更频繁出现。OUD首发组患者在这四组中HIV感染率（4.7%）和丙型肝炎病毒（HCV；28.2%）感染率也最高。疼痛首发组患者精神障碍（81.7%）、心脏病（72.0%）、呼吸系统疾病（68.4%）、睡眠障碍（41.8%）、癌症（23.4%）和糖尿病（19.3%）的发生率最高。
OUD之前出现慢性疼痛状况的惊人高发生率以及相关的严重精神健康和身体健康状况，需要更好的评估模式和协调的护理计划来应对这些复杂的医疗状况。
