要还是不要：自我认定的慢性疼痛患者中，对成瘾风险的感知、对预期镇痛效果的预期和尝试新型止痛药的可能性之间的关联。
To take or not to take: the association between perceived addiction risk, expected analgesic response and likelihood of trying novel pain relievers in self-identified chronic pain patients.
机构信息
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Psychology, California State University, Chico, Chico, CA, USA.
出版信息
Addiction. 2018 Jan;113(1):67-79. doi: 10.1111/add.13922. Epub 2017 Aug 10.
BACKGROUND AND AIMS
Probability discounting refers to the effect of outcome uncertainty on decision making. Using probability discounting, we examined the degree to which self-identified chronic pain patients (CPP) were likely to try a novel analgesic medication given increasing addiction risk. We postulated that propensity for opioid misuse, trait impulsivity and previous opioid experience would be associated positively with likelihood of risky medication use.
DESIGN
This cross-sectional on-line study determined state/trait associations with addiction-related medication decisions in CPP.
SETTING
US-based CPP participated via Amazon Mechanical Turk; data were collected and analyzed in Baltimore, Maryland.
PARTICIPANTS
A total of 263 CPP (70.6% female) participated in the study from 12-13 December 2014.
MEASUREMENTS
CPP responded to the Benefit versus Addiction Risk Questionnaire (BARQ) assessing likelihood of taking a hypothetical once-daily oral analgesic medication as a function of two factors: risk of addiction (0-50%) and duration of expected complete pain relief (3, 30 or 365 days). The primary outcome was the BARQ, quantified as area under the curve (AUC). Grouping of CPP at high or low risk for opioid misuse was based on the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). Predictors included previous experience with opioids, as well as various measures of chronic pain and mental health.
FINDINGS
Across hypothetical addiction risk assessed in the BARQ, the likelihood of taking a novel analgesic medication was elevated significantly in patients with high (≥18; n = 137) versus low (<18; n = 126) SOAPP-R scores [P < 0.001; 3-day: Cohen's d = 0.66, 95% confidence interval (CI) = 0.63, 0.69; 30-day: d = 0.74, 95% CI = 0.71, 0.78; 365-day: d = 0.75, 95% CI = 0.72, 0.79].
CONCLUSIONS
In the United States, self-identified chronic pain patients (CPP) at higher risk for opioid misuse were more likely to report willingness to try a novel analgesic despite increasing addiction risk than CPP with low risk of opioid misuse.
背景和目的
概率折扣是指结果不确定性对决策的影响。使用概率折扣，我们研究了自我认定的慢性疼痛患者（CPP）在成瘾风险增加的情况下尝试新型镇痛药物的可能性。我们假设，阿片类药物滥用倾向、特质冲动和以前的阿片类药物使用经验与冒险用药的可能性呈正相关。
设计
这项横断面在线研究确定了 CPP 中与成瘾相关的药物决策的状态/特质关联。
设置
美国 CPP 通过亚马逊 Mechanical Turk 参与；数据在马里兰州巴尔的摩收集和分析。
参与者
共有 263 名 CPP（70.6%为女性）于 2014 年 12 月 12 日至 13 日参加了这项研究。
测量
CPP 对收益与成瘾风险问卷（BARQ）进行了回答，该问卷评估了作为两个因素的函数，即成瘾风险（0-50%）和预期完全缓解疼痛的持续时间（3、30 或 365 天）下服用一种假设的每日一次口服镇痛药的可能性。主要结果是 BARQ，以曲线下面积（AUC）量化。根据筛选器和疼痛患者阿片类药物评估修订版（SOAPP-R），将 CPP 分组为高或低阿片类药物滥用风险。预测因素包括以前使用阿片类药物的经验，以及各种慢性疼痛和心理健康的测量。
发现
在 BARQ 中评估的假设成瘾风险中，具有较高（≥18；n=137）与较低（<18；n=126）SOAPP-R 评分的患者服用新型镇痛药的可能性显著升高[P<0.001；3 天：Cohen's d=0.66，95%置信区间（CI）=0.63，0.69；30 天：d=0.74，95%CI=0.71，0.78；365 天：d=0.75，95%CI=0.72，0.79]。
结论
在美国，自我认定的慢性疼痛患者（CPP）中，阿片类药物滥用风险较高的患者比滥用风险较低的患者更有可能报告愿意尝试新型镇痛药，尽管成瘾风险增加。
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