Department of Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States.
Programs of Excellence in Addictions Research, Washington State University, Spokane, WA, United States.
Pain. 2018 Oct;159(10):2097-2104. doi: 10.1097/j.pain.0000000000001315.
Little is known about changes in pain intensity that may occur after discontinuation of long-term opioid therapy (LTOT). The objective of this study was to characterize pain intensity after opioid discontinuation over 12 months. This retrospective U.S. Department of Veterans Affairs (VA) administrative data study identified N = 551 patients nationally who discontinued LTOT. Data over 24 months (12 months before and after discontinuation) were abstracted from VA administrative records. Random-effects regression analyses examined changes in 0 to 10 pain numeric rating scale scores over time, whereas growth mixture models delineated pain trajectory subgroups. Mean estimated pain at the time of opioid discontinuation was 4.9. Changes in pain after discontinuation were characterized by slight but statistically nonsignificant declines in pain intensity over 12 months after discontinuation (B = -0.20, P = 0.14). Follow-up growth mixture models identified 4 pain trajectory classes characterized by the following postdiscontinuation pain levels: no pain (average pain at discontinuation = 0.37), mild clinically significant pain (average pain = 3.90), moderate clinically significant pain (average pain = 6.33), and severe clinically significant pain (average pain = 8.23). Similar to the overall sample, pain trajectories in each of the 4 classes were characterized by slight reductions in pain over time, with patients in the mild and moderate pain trajectory categories experiencing the greatest pain reductions after discontinuation (B = -0.11, P = 0.05 and B = -0.11, P = 0.04, respectively). Pain intensity after discontinuation of LTOT does not, on average, worsen for patients and may slightly improve, particularly for patients with mild-to-moderate pain at the time of discontinuation. Clinicians should consider these findings when discussing risks of opioid therapy and potential benefits of opioid taper with patients.
关于长期阿片类药物治疗 (LTOT) 停药后疼痛强度可能发生的变化知之甚少。本研究的目的是描述停药后 12 个月内疼痛强度的变化。这是一项美国退伍军人事务部 (VA) 的回顾性行政数据研究，全国范围内共确定了 551 名停止 LTOT 的患者。从 VA 行政记录中提取了 24 个月的数据（停药前 12 个月和停药后 12 个月）。随机效应回归分析考察了 0 到 10 的疼痛数字评分量表评分随时间的变化，而增长混合模型则描绘了疼痛轨迹亚组。阿片类药物停药时的平均估计疼痛为 4.9。停药后疼痛变化的特征是停药后 12 个月内疼痛强度略有但无统计学意义的下降（B = -0.20，P = 0.14）。随访的增长混合模型确定了 4 个疼痛轨迹类别，其特征是停药后以下疼痛水平：无疼痛（停药时的平均疼痛= 0.37）、轻度临床显著疼痛（平均疼痛= 3.90）、中度临床显著疼痛（平均疼痛= 6.33）和重度临床显著疼痛（平均疼痛= 8.23）。与总体样本类似，每个类别中的疼痛轨迹均表现为随时间的轻微疼痛减轻，停药后轻度和中度疼痛轨迹类别的患者疼痛减轻最大（B = -0.11，P = 0.05 和 B = -0.11，P = 0.04）。LTOT 停药后疼痛强度平均不会恶化，患者可能会略有改善，特别是在停药时疼痛处于轻度至中度的患者。当与患者讨论阿片类药物治疗的风险和阿片类药物逐渐减少的潜在益处时，临床医生应考虑这些发现。
