Zgierska Aleksandra E, Ircink James, Burzinski Cindy A, Mundt Marlon P
Assistant Professor, Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
Medical Student, Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
J Opioid Manag. 2017 May/Jun;13(3):169-181. doi: 10.5055/jom.2017.0384.
Opioid-treated chronic low back pain (CLBP) is debilitating, costly, and often refractory to existing treatments. This secondary analysis aims to pilot-test the hypothesis that mindfulness meditation (MM) can reduce economic burden related to opioid-treated CLBP.
Twenty-six-week unblinded pilot randomized controlled trial, comparing MM, adjunctive to usual-care, to usual care alone.
Outpatient.
Thirty-five adults with opioid-treated CLBP (≥30 morphine-equivalent mg/day) for 3 + months enrolled; none withdrew.
Eight weekly therapist-led MM sessions and at-home practice.
Costs related to self-reported healthcare utilization, medication use (direct costs), lost productivity (indirect costs), and total costs (direct + indirect costs) were calculated for 6-month pre-enrollment and postenrollment periods and compared within and between the groups.
Participants (21 MM; 14 control) were 20 percent men, age 51.8 ± 9.7 years, with severe disability, opioid dose of 148.3 ± 129.2 morphine-equivalent mg/d, and individual annual income of $18,291 ± $19,345. At baseline, total costs were estimated at $15,497 ± 13,677 (direct: $10,635 ± 9,897; indirect: $4,862 ± 7,298) per participant. Although MM group participants, compared to controls, reduced their pain severity ratings and pain sensitivity to heat stimuli (p < 0.05), no statistically significant within-group changes or between-group differences in direct and indirect costs were noted.
Adults with opioid-treated CLBP experience a high burden of disability despite the high costs of treatment. Although this pilot study did not show a statistically significant impact of MM on costs related to opioid-treated CLBP, MM can improve clinical outcomes and should be assessed in a larger trial with long-term follow-up.
阿片类药物治疗的慢性下腰痛（CLBP）使人虚弱，成本高昂，且往往对现有治疗方法无效。这项二次分析旨在初步检验正念冥想（MM）可减轻与阿片类药物治疗的CLBP相关的经济负担这一假设。
为期26周的非盲法初步随机对照试验，将MM（作为常规护理的辅助手段）与单纯常规护理进行比较。
门诊。
35名接受阿片类药物治疗CLBP（≥30毫克吗啡当量/天）达3个月以上的成年人入组；无人退出。
由治疗师指导的每周8次MM课程及在家练习。
计算入组前6个月和入组后6个月与自我报告的医疗保健利用、药物使用（直接成本）、生产力损失（间接成本）以及总成本（直接成本+间接成本）相关的费用，并在组内和组间进行比较。
参与者（21名MM组；14名对照组）中男性占20%，年龄51.8±9.7岁，有严重残疾，阿片类药物剂量为148.3±129.2毫克吗啡当量/天，个人年收入为18,291±19,345美元。在基线时，每位参与者的总成本估计为15,497±13,677美元（直接成本：10,635±9,897美元；间接成本：4,862±7,298美元）。尽管与对照组相比，MM组参与者降低了疼痛严重程度评分以及对热刺激的疼痛敏感性（p<0.05），但在直接成本和间接成本方面，未观察到组内有统计学意义的变化或组间差异。
尽管治疗成本高昂，但接受阿片类药物治疗的CLBP成年人仍面临着沉重的残疾负担。虽然这项初步研究未显示MM对与阿片类药物治疗的CLBP相关的成本有统计学意义的影响，但MM可改善临床结局，应在一项长期随访的更大规模试验中进行评估。
