Department of Anesthesiology, University of Arizona, Tucson, AZ; Department of Pharmacology, University of Arizona, Tucson, AZ.
Department of Anesthesiology, University of Arizona, Tucson, AZ.
Pain Physician. 2018 Nov;21(6):E603-E610.
The management of chronic nonmalignant pain with high-dose opioids has partially contributed to the current opioid epidemic, with some responsibility shared by chronic pain clinics. Traditionally, both primary care providers and patients used chronic pain clinics as a source for continued medical management of patients on high-dose opioids, often resulting in tolerance and escalating doses. Although opioids continue to be an important component of the management of some chronic pain conditions, improvement in function and comfort must be documented. Pain clinics are ideally suited for reducing opioid usage while improving pain and function with the use of a multimodal approach to pain management. We assessed whether the application of multimodal treatment directed by pain specialists in a pain clinic provides for improved function and reduced dosages of opioid analgesics.
We evaluated the role of a pain clinic staffed by fellowship-trained pain physicians in reducing pain and opioid use in chronic nonmalignant pain patients.
This study used a retrospective design.
The research took place in an outpatient pain clinic in a tertiary referral center/teaching hospital.
Of 1268 charts reviewed, 296 patients were on chronic opioids at the time of first evaluation. After a thorough evaluation, the patients were treated with nonopioid pharmacotherapy and interventional pain procedures as necessary. The data utilized from patients' latest follow-up visit included current pain level using the Numerical Rating Scale (NRS-11), opioid usage, and various functional parameters.
NRS-11 scores decreased by 33.8% from 6.8 (± 0.1)/10 to 4.5 (± 0.2)/10. The pain frequency and number of pain episodes improved by 36.8 ± 2 and 36.2 ± 2.1, respectively. Additionally, the ability to sleep, work, and perform chores significantly improved. Total opioid use decreased by about 55.4% from 53.8 ± 4 to about 24 ± 2.8 MME/patient/day.
This study is not a randomized prospective controlled study. The patients analyzed are still getting therapy and their pain status may change. Some opioids are underrepresented in the analyzed cohort. Finally, this study lacks in-depth stratification by type of pain, age, gender, and duration of opioid use.
Chronic pain clinics can play a pivotal role in reducing opioid usage while improving pain and function in patients on chronic opioids. We wish to emphasize the importance of allocating resources toward nonopioid treatments that may improve the function and well-being of patients.
Pain clinic, pain management, multimodal pain management, chronic pain, opioid reduction, improved pain, improved functional capacity.
高剂量阿片类药物治疗慢性非恶性疼痛在一定程度上导致了目前的阿片类药物流行，慢性疼痛诊所也对此负有部分责任。传统上，初级保健提供者和患者都将慢性疼痛诊所用作继续管理高剂量阿片类药物患者的医疗管理的来源，这通常导致了耐受和剂量升级。尽管阿片类药物仍然是一些慢性疼痛疾病管理的重要组成部分，但必须记录功能和舒适度的改善。疼痛诊所非常适合通过使用多模式疼痛管理方法来减少阿片类药物的使用，同时改善疼痛和功能。我们评估了由疼痛专家在疼痛诊所应用多模式治疗是否能改善慢性非恶性疼痛患者的功能和减少阿片类药物的用量。
我们评估了由疼痛专科医生组成的疼痛诊所减少慢性非恶性疼痛患者疼痛和阿片类药物使用的作用。
本研究使用回顾性设计。
研究在三级转诊中心/教学医院的门诊疼痛诊所进行。
在审查的 1268 份图表中，有 296 名患者在首次评估时正在服用慢性阿片类药物。在进行彻底评估后，根据需要对患者进行非阿片类药物药物治疗和介入性疼痛治疗。从患者最近的随访中获取的数据包括当前疼痛水平（使用数字评分量表[NRS-11]）、阿片类药物使用情况以及各种功能参数。
NRS-11 评分从 6.8（±0.1）/10 降至 4.5（±0.2）/10，下降了 33.8%。疼痛频率和疼痛发作次数分别改善了 36.8±2 和 36.2±2.1。此外，睡眠、工作和做家务的能力也显著改善。总阿片类药物用量从 53.8±4 降至约 24±2.8 MME/患者/天，减少了约 55.4%。
本研究不是一项随机前瞻性对照研究。分析的患者仍在接受治疗，他们的疼痛状况可能会发生变化。在分析的队列中，有些阿片类药物代表性不足。最后，本研究缺乏按疼痛类型、年龄、性别和阿片类药物使用时间进行深入分层。
慢性疼痛诊所可以在减少慢性阿片类药物患者的阿片类药物使用量的同时，改善疼痛和功能。我们希望强调分配资源用于非阿片类药物治疗的重要性，这可能会改善患者的功能和幸福感。
疼痛诊所、疼痛管理、多模式疼痛管理、慢性疼痛、阿片类药物减少、疼痛改善、功能能力改善。
