Guildford Beth J, Daly-Eichenhardt Aisling, Hill Bethany, Sanderson Karen, McCracken Lance M
INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
NIHR Maudsley Biomedical Research Centre, King's Health Partners, London, UK.
Br J Pain. 2018 May;12(2):72-86. doi: 10.1177/2049463717734016. Epub 2017 Oct 2.
Long-term use of opioid medication is associated with a host of negative effects on health and quality of life. Guidelines state that people with chronic pain taking high doses of opioids without benefit should be supported to discontinue them. Little research has investigated psychological processes associated with analgesic use and tapering. This study investigated (1) analgesic use pre- and post-participation in an interdisciplinary pain management programme and its relationship to functioning and (2) psychological processes associated with analgesic use. Opioid use was associated with poorer functioning at baseline. Participating in an interdisciplinary pain management programme was associated with reductions in opioid dose and number of classes of analgesics used. Reductions in analgesic use were associated with improvements in functioning. Psychological inflexibility was associated with using higher doses of opioid medication and with using a greater number of classes of analgesics. Psychological flexibility appears relevant in explaining analgesic use. Future research could focus on targeting this process to improve tapering outcomes.
长期使用阿片类药物会对健康和生活质量产生一系列负面影响。指南指出，患有慢性疼痛且服用高剂量阿片类药物却无益处的人应得到支持以停用这些药物。很少有研究调查与镇痛药使用及逐渐减量相关的心理过程。本研究调查了：（1）参与跨学科疼痛管理项目前后的镇痛药使用情况及其与功能的关系，以及（2）与镇痛药使用相关的心理过程。阿片类药物的使用在基线时与较差的功能相关。参与跨学科疼痛管理项目与阿片类药物剂量及所使用镇痛药种类数量的减少有关。镇痛药使用的减少与功能的改善有关。心理僵化与使用更高剂量的阿片类药物以及使用更多种类的镇痛药有关。心理灵活性似乎在解释镇痛药使用方面具有相关性。未来的研究可以聚焦于针对这一过程以改善逐渐减量的结果。
