Ariel University, Ariel, Israel; Dual Diagnosis Clinic, Lev-Hasharon Medical Center, Pardesiya, Israel.
Pain Center, Sourasky Medical Center, Tel Aviv, Israel.
Gen Hosp Psychiatry. 2017 Jul;47:36-42. doi: 10.1016/j.genhosppsych.2017.04.006. Epub 2017 May 1.
In the past two decades, chronic pain has been increasingly treated with prescription opioids, particularly in developed countries. This has drawn public concern of possible risks associated with the potential misuse of prescriptions opioids. Previous research has indicated that this may be particularly true among individuals suffering from co-occurring psychiatric disorders. The present study sought to explore rates of misuse among chronic pain patients prescribed opioids, comparing individuals with and without anxiety.
Chronic pain patients receiving prescription opioids (N=554) were screened for anxiety using the Generalized Anxiety Disorder (GAD-7) scale and for opioid misuse using the Current Opioid Misuse Measure (COMM).
Among patients who screened positive for anxiety (GAD-7≥10), 50% also screened positive for opioid misuse, compared to 10% among those without anxiety. After controlling for possible confounding sociodemographic and clinical variables, patients with anxiety were significantly more prone to screen positive for opioid misuse (Adjusted Odds Ratio (AOR)=2.18; 95% Confidence Interval (CI)=1.37-4.17) compared to those without anxiety. This was maintained when conducting separate comparisons for severe, but not mild or moderate, level of anxiety.
These findings highlight the importance of detecting and addressing co-occurring anxiety when treating patients with chronic pain who receive prescription opioids.
在过去的二十年中，慢性疼痛的治疗中越来越多地使用处方类阿片药物，尤其是在发达国家。这引起了公众对潜在滥用处方类阿片药物相关风险的关注。先前的研究表明，对于同时患有精神疾病的个体来说，这种情况可能更为明显。本研究旨在探索接受阿片类药物处方治疗的慢性疼痛患者中药物滥用的发生率，并比较同时患有和不患有焦虑症的患者。
使用广泛性焦虑障碍量表（GAD-7）对接受处方类阿片药物治疗的慢性疼痛患者进行焦虑筛查，并使用当前阿片类药物滥用量表（COMM）进行阿片类药物滥用筛查。
在筛查出患有焦虑症（GAD-7≥10）的患者中，有 50%同时也筛查出阿片类药物滥用，而在没有焦虑症的患者中，这一比例为 10%。在控制了可能存在的混杂社会人口学和临床变量后，患有焦虑症的患者明显更容易筛查出阿片类药物滥用阳性（调整后的优势比（AOR）=2.18；95%置信区间（CI）=1.37-4.17），而没有焦虑症的患者则没有这种情况。当对严重程度的焦虑症（而非轻度或中度）进行单独比较时，结果保持不变。
这些发现强调了在治疗接受处方类阿片药物治疗的慢性疼痛患者时，检测和处理同时存在的焦虑症的重要性。
