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慢性疼痛患者的药物依赖:一项回顾性研究。

Drug dependence in patients with chronic pain: A retrospective study.

作者信息

Tetsunaga Tomoko, Tetsunaga Tomonori, Nishida Keiichiro, Kanzaki Hirotaka, Misawa Haruo, Takigawa Tomoyuki, Shiozaki Yasuyuki, Ozaki Toshifumi

机构信息

Department of Orthopaedic Surgery, Okayama University Hospital, Okayama.

Department of Orthopaedic Surgery, Kurashiki Municipal Hospital, Kurashiki.

出版信息

Medicine (Baltimore). 2018 Oct;97(40):e12748. doi: 10.1097/MD.0000000000012748.

Abstract

Drug dependence, which can exist concurrently with chronic pain, is seen as one of the major causes of rapidly increasing medical expenses. However, drug dependence in patients with chronic pain has not been evaluated. The aim of this study was to identify the risk factors for drug dependence in patients with chronic noncancer pain.This retrospective study included 151 patients with chronic noncancer pain (43 males, 108 females; mean age, 72 years). Low back pain (LBP) occurred in 96 patients, whereas 22 had shoulder pain, 8 had hip pain, and 77 had knee pain. Patients were divided into drug dependence and nondrug dependence groups based on the Severity of Dependence Scale (SDS) scores. Patients with SDS scores ≥5 and <5 were classified into drug dependence and nondrug dependence groups, respectively. All patients completed self-report questionnaires. Factors that predict drug dependence were identified by performing univariate and multivariate analyses.Sixty (40%) of the 151 patients met the SDS criteria for drug dependence. Significant differences were found between patients with and without drug dependence for the LBP, hip pain, number of medications, and for the Numerical Rating Scale, Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale, and Pain Catastrophizing Scale (PCS) scores. Multiple regression analysis identified LBP, hip pain, PCS, and PDAS scores as factors related to drug dependence in patients with chronic noncancer pain.Drug dependence tends to differ in patients based on the location of their chronic pain. Pain catastrophizing and disability indicated a greater tendency for drug dependence. Thus, PCS and PDAS scores are useful screening tools for predicting drug dependence in patients with chronic pain.

摘要

药物依赖可能与慢性疼痛同时存在,被视为医疗费用迅速增加的主要原因之一。然而,慢性疼痛患者的药物依赖情况尚未得到评估。本研究的目的是确定慢性非癌性疼痛患者药物依赖的危险因素。

这项回顾性研究纳入了151例慢性非癌性疼痛患者(男性43例,女性108例;平均年龄72岁)。96例患者出现腰痛,22例有肩部疼痛,8例有髋部疼痛,77例有膝部疼痛。根据药物依赖严重程度量表(SDS)评分将患者分为药物依赖组和非药物依赖组。SDS评分≥5分和<5分的患者分别被归类为药物依赖组和非药物依赖组。所有患者均完成了自我报告问卷。通过单因素和多因素分析确定预测药物依赖的因素。

151例患者中有60例(40%)符合药物依赖的SDS标准。在有和没有药物依赖的患者之间,腰痛、髋部疼痛、用药数量以及数字评分量表、疼痛残疾评估量表(PDAS)、医院焦虑抑郁量表和疼痛灾难化量表(PCS)评分存在显著差异。多元回归分析确定腰痛、髋部疼痛、PCS和PDAS评分是慢性非癌性疼痛患者药物依赖的相关因素。

药物依赖在慢性疼痛部位不同的患者中往往有所差异。疼痛灾难化和残疾表明药物依赖的倾向更大。因此,PCS和PDAS评分是预测慢性疼痛患者药物依赖的有用筛查工具。

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