Birke H, Ekholm O, Sjøgren P, Kurita G P, Højsted J
Department of Oncology, Rigshospitalet Copenhagen University Hospital, Denmark.
National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
Eur J Pain. 2017 Oct;21(9):1516-1527. doi: 10.1002/ejp.1053. Epub 2017 May 8.
Longitudinal population-based studies of long-term opioid therapy (L-TOT) in chronic non-cancer pain (CNCP) patients are sparse. Our study investigated incidence and predictors for initiating L-TOT and changes in self-rated health, pain interference and physical activities in long-term opioid users.
Data were obtained from the national representative Danish Health and Morbidity Surveys and The Danish National Prescription Registry. Respondents with no dispensed opioids the year before the survey were followed from 2000 and from 2005 until the end of 2012 (n = 12,145). A nationally representative subsample of individuals (n = 2015) completed the self-administered questionnaire in both 2000 and 2013. Collected information included chronic pain (≥6 months), health behaviour, self-rated health, pain interference with work activities and physical activities. Long-term users were defined as those who were dispensed at least one opioid prescription in six separate months within a year.
The incidence of L-TOT was substantially higher in CNCP patients at baseline than in others (9/1000 vs. 2/1000 person-years). Smoking behaviour and dispensed benzodiazepines were significantly associated with initiation of L-TOT in individuals with CNCP at baseline. During follow-up, L-TOT in CNCP patients increased the likelihood of negative changes in pain interference with work (OR 9.2; 95% CI 1.9-43.6) and in moderate activities (OR 3.7; 95% CI 1.1-12.6). The analysis of all individuals indicated a dose-response relationship between longer treatment duration and the risk of experiencing negative changes.
Individuals on L-TOT seemed not to achieve the key goals of opioid therapy: pain relief, improved quality of life and functional capacity.
Long-term opioid therapy does not seem to provide pain relief, improvement in HRQOL and physical capacity in CNCP patients in a general population.
针对慢性非癌性疼痛（CNCP）患者长期阿片类药物治疗（L-TOT）的基于人群的纵向研究较少。我们的研究调查了L-TOT的起始发生率及预测因素，以及长期阿片类药物使用者自评健康状况、疼痛干扰和身体活动的变化。
数据来自具有全国代表性的丹麦健康与发病率调查以及丹麦国家处方登记处。对在调查前一年未使用过阿片类药物的受访者从2000年开始跟踪，2005年起的受访者跟踪至2012年底（n = 12,145）。一个具有全国代表性的个体子样本（n = 2015）在2000年和2013年都完成了自填式问卷。收集的信息包括慢性疼痛（≥6个月）、健康行为、自评健康状况、疼痛对工作活动和身体活动的干扰。长期使用者定义为在一年内有六个月分别至少开具过一张阿片类药物处方的人。
基线时CNCP患者中L-TOT的发生率显著高于其他人（9/1000人年 vs. 2/1000人年）。吸烟行为和已开具的苯二氮䓬类药物与基线时患有CNCP的个体开始L-TOT显著相关。在随访期间，CNCP患者的L-TOT增加了疼痛对工作干扰（OR 9.2；95% CI 1.9 - 43.6）和中度活动干扰（OR 3.7；95% CI 1.1 - 12.6）出现负面变化的可能性。对所有个体的分析表明，治疗持续时间越长与出现负面变化风险之间存在剂量反应关系。
接受L-TOT的个体似乎未实现阿片类药物治疗的关键目标：缓解疼痛、改善生活质量和功能能力。
在普通人群的CNCP患者中，长期阿片类药物治疗似乎无法缓解疼痛、改善健康相关生活质量和身体能力。
