Häuser W, Schubert T, Scherbaum N, Tölle T
Innere Medizin 1, Klinikum Saarbrücken GmbH, Winterberg 1, 66119, Saarbrücken, Deutschland.
Klinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München, München, Deutschland.
Schmerz. 2018 Dec;32(6):419-426. doi: 10.1007/s00482-018-0324-4.
One major concern of long-term opioid therapy (LTOT) for chronic noncancer pain (CNCP) is the risk of abuse of prescribed opioids.
To examine the prevalence and predictors of opioid use-related hospitalizations and potential abuse of prescribed opioids by persons with LTOT for CNCP in a sample representative of the German statutory health insurance companies.
Retrospective cross-sectional study in 2014. Anonymized German health claims database, including 4,028,618 insured individuals of 69 German statutory health insurances. Univariate logistic regression models to evaluate demographic and medical characteristics associated with hospital stays and a diagnosis of mental and behavioral disorders due to alcohol, opioids, tranquilizers, multiple substances and intoxications by narcotic agents in insured individuals with CNCP receiving LTOT.
The prevalence of LTOT for CNCP was 0.8%; 9.9% of these insured individuals received high-dose LTOT (≥120 morphine equivalent mg/day). The 1‑year prevalence of hospital stays with a diagnosis of mental and behavioral disorders due to alcohol, opioids, tranquilizers, multiple substances and intoxications by narcotic agents was 1.75% of persons with LTOT. These diagnoses were strongly associated with prescriptions of tranquilizers (odds ratio [OR] 3.63; 95% confidence interval [CI] 3.03; 4.36) and moderately associated with diagnosis of depression (OR 2.52; 95% CI 2.12; 3.00) and slightly associated with diagnosis of somatoform pain disorder (OR 1.89; 95% CI 1.56; 2.28) and high-dose LTOT (OR 1.81; 95% CI 1.44; 2.27).
The study is in line with the recommendations of the German national guidelines on long-term opioid therapy of chronic non-cancer pain (LONTS) to avoid concomitant prescription of tranquilizers for CNCP and to carefully select and monitor patients with depression and somatoform pain disorder.
长期阿片类药物治疗（LTOT）用于慢性非癌性疼痛（CNCP）的一个主要担忧是处方阿片类药物被滥用的风险。
在一个代表德国法定健康保险公司的样本中，研究接受LTOT治疗CNCP的患者中与阿片类药物使用相关的住院率及处方阿片类药物潜在滥用的患病率和预测因素。
2014年的回顾性横断面研究。使用匿名的德国健康索赔数据库，其中包括69家德国法定健康保险公司的4,028,618名参保人员。采用单因素逻辑回归模型评估接受LTOT治疗CNCP的参保人员中与住院以及酒精、阿片类药物、镇静剂、多种物质和麻醉剂中毒所致精神和行为障碍诊断相关的人口统计学和医学特征。
CNCP的LTOT患病率为0.8%；这些参保人员中有9.9%接受高剂量LTOT（≥120毫克吗啡当量/天）。因酒精、阿片类药物、镇静剂、多种物质和麻醉剂中毒而诊断为精神和行为障碍的住院患者在接受LTOT治疗的患者中的1年患病率为1.75%。这些诊断与镇静剂处方密切相关（比值比[OR]3.63；95%置信区间[CI]3.03；4.36），与抑郁症诊断中度相关（OR 2.52；95%CI 2.12；3.00），与躯体形式疼痛障碍诊断轻度相关（OR 1.89；95%CI 1.56；2.28），与高剂量LTOT轻度相关（OR 1.81；95%CI 1.44；2.27）。
该研究符合德国慢性非癌性疼痛长期阿片类药物治疗国家指南（LONTS）的建议，即避免为CNCP同时开具镇静剂处方，并仔细挑选和监测患有抑郁症和躯体形式疼痛障碍的患者。
