长期阿片类药物治疗患者慢性疼痛非药物治疗策略的使用相关性和有效性认知。
Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy.
机构信息
VA Portland Health Care System, Portland, OR, USA.
Oregon Health & Science University, Portland, OR, USA.
出版信息
J Gen Intern Med. 2018 May;33(Suppl 1):46-53. doi: 10.1007/s11606-018-4325-x.
OBJECTIVE
Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of NPTs. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy (LTOT).
METHODS
Participants (n = 517) with musculoskeletal pain who were prescribed LTOT were recruited from two integrated health systems. They rated the frequency and utility of six clinician-directed and five self-directed NPTs for chronic pain. We categorized NPT use at four levels based on number of interventions used and frequency of use (none, low, moderate, high). Analyses examined clinical and demographic factors that differed among groups for both clinician-directed and self-directed NPTs.
RESULTS
Seventy-one percent of participants reported use of any NPT for pain within the prior 6 months. NPTs were rated as being helpful by more than 50% of users for all treatments assessed (range 51-79%). High users of clinician-directed NPTs were younger than non-users or low-frequency users and had the most depressive symptoms. In both clinician-directed and self-directed categories, high NPT users had significantly higher pain disability compared to non-NPT users. No significant group differences were detected on other demographic or clinical variables. In multivariable analyses, clinician-directed NPT use was modestly associated with younger age (OR = 0.97, 95% CI = 0.96-0.98) and higher pain disability (OR = 1.01, 95% CI = 1.00-1.02). Variables associated with greater self-directed NPT use were some college education (OR = 1.80, 95% CI = 1.13-2.84), college graduate or more (OR = 2.02, 95% CI = 1.20-3.40), and higher pain disability (OR = 1.01, 95% CI = 1.01-1.02).
CONCLUSIONS
NPT use was associated with higher pain disability and younger age for both clinician-directed and self-directed NPTs and higher education for self-directed NPTs. These strategies were rated as helpful by those that used them. These results can inform intervention implementation and be used to increase engagement in NPTs for chronic pain.
目的
非药物治疗（NPT）被推荐用于慢性疼痛。关于患者使用或对 NPT 的认知的信息有限。我们研究了长期使用阿片类药物治疗（LTOT）的患者中 NPT 用于慢性疼痛的频率、相关性以及自我评估的有效性。
方法
从两个综合医疗系统招募了 517 名患有肌肉骨骼疼痛并被开具 LTOT 的参与者。他们对六种临床指导和五种自我指导的 NPT 治疗慢性疼痛的频率和效用进行了评分。我们根据使用的干预措施数量和使用频率（无、低、中、高）将 NPT 使用分为四个级别。分析检查了临床和人口统计学因素，这些因素在使用和不使用自我指导 NPT 的群体中存在差异。
结果
71%的参与者报告在过去 6 个月内使用过任何 NPT 治疗疼痛。所有评估的治疗方法中，超过 50%的使用者认为 NPT 有用（范围为 51-79%）。与非使用者或低频率使用者相比，临床指导 NPT 的高频使用者更年轻，且抑郁症状更严重。在临床指导和自我指导两类中，高频 NPT 使用者的疼痛残疾程度明显高于非 NPT 使用者。在其他人口统计学或临床变量上，没有发现显著的组间差异。在多变量分析中，临床指导 NPT 的使用与年龄较小（OR=0.97，95%CI=0.96-0.98）和较高的疼痛残疾（OR=1.01，95%CI=1.00-1.02）呈弱相关。与更多自我指导 NPT 使用相关的变量是一些大学教育（OR=1.80，95%CI=1.13-2.84）、大学毕业或以上（OR=2.02，95%CI=1.20-3.40）和更高的疼痛残疾（OR=1.01，95%CI=1.01-1.02）。
结论
对于临床指导和自我指导的 NPT，NPT 的使用与更高的疼痛残疾和更年轻的年龄相关，而对于自我指导的 NPT，更高的教育程度相关。这些策略被使用它们的人评为有用。这些结果可以为干预措施的实施提供信息，并用于增加慢性疼痛患者对 NPT 的参与。
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