阿片类药物依赖和药物过度使用性头痛的严重程度。
Severity of Analgesic Dependence and Medication-overuse Headache.
机构信息
Research Centre, Akershus University Hospital, Lørenskog (CL, ESK); Department of Neurology, Akershus University Hospital, Nordbyhagen (CL, ESK); Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway (CL, MBR); National Addiction Centre, King's College, London, UK (MG); Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog (MBR); Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway (JS, ESK).
出版信息
J Addict Med. 2019 Sep/Oct;13(5):346-353. doi: 10.1097/ADM.0000000000000504.
BACKGROUND AND AIMS
Medication-overuse headache (MOH) is a common chronic headache caused by overuse of headache analgesics. It has similarities with substance dependence disorders. The treatment of choice for MOH is withdrawal of the offending analgesics. Behavioral brief intervention treatment using methods adapted from substance misuse settings is effective. Here we investigate the severity of analgesics dependence in MOH using the Severity of Dependence Scale (SDS), validate the SDS score against formal substance dependence diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and examine whether the SDS predicts successful withdrawal.
METHODS
Representative recruitment from the general population; 60 MOH patients, 15 chronic headache patients without medication overuse and 25 population controls. Headaches were diagnosed using the International Classification of Headache Disorders, medication use was assessed and substance dependence classified according to the DSM-IV. The SDS was scored by interviewers blinded to patient group. Descriptive statistics were used and validity of the SDS score assessed against a substance dependence diagnosis using ROC analysis.
RESULTS
Sixty-two percent of MOH patients overused simple analgesics, 38% centrally acting analgesics (codeine, opiates, triptans). Fifty percent of MOH patients were classified as DSM-IV substance dependent. Centrally active medication and high SDS scores were associated with higher proportions of dependence. ROC analysis showed SDS scores accurately identified dependence (area under curve 88%). Lower SDS scores were associated with successful withdrawal (P = 0.004).
CONCLUSIONS
MOH has characteristics of substance dependence which should be taken into account when choosing treatment strategy.
TRIAL REGISTRATION
Based on data collected in previously reported randomized BIMOH trial (; in the present manuscript, Clinical trials registration number: NCT01314768). The present part, however, represents observational data and is not a treatment trial.
背景和目的
药物过度使用性头痛（MOH）是一种常见的慢性头痛，由过度使用头痛镇痛药引起。它与物质依赖障碍有相似之处。MOH 的首选治疗方法是停用引起头痛的镇痛药。使用改编自物质滥用环境的行为简短干预治疗是有效的。在这里，我们使用依赖严重程度量表（SDS）来研究 MOH 中镇痛药依赖的严重程度，根据精神障碍诊断与统计手册，第 4 版（DSM-IV）的正式物质依赖诊断来验证 SDS 评分，并检查 SDS 是否可以预测成功戒断。
方法
从普通人群中进行代表性招募；共纳入 60 例 MOH 患者、15 例无药物过度使用的慢性头痛患者和 25 例人群对照。使用国际头痛疾病分类对头痛进行诊断，评估药物使用情况，并根据 DSM-IV 对物质依赖进行分类。SDS 由对患者分组不知情的访谈者进行评分。使用描述性统计方法，通过 ROC 分析评估 SDS 评分与物质依赖诊断的有效性。
结果
62%的 MOH 患者过度使用简单镇痛药，38%的中枢作用镇痛药（可待因、阿片类药物、曲坦类药物）。50%的 MOH 患者被归类为 DSM-IV 物质依赖者。中枢活性药物和高 SDS 评分与更高比例的依赖相关。ROC 分析表明 SDS 评分准确识别依赖（曲线下面积 88%）。较低的 SDS 评分与成功戒断相关（P=0.004）。
结论
MOH 具有物质依赖的特征，在选择治疗策略时应予以考虑。
试验注册
基于先前报道的随机 BIMOH 试验中收集的数据（；在本手稿中，临床试验注册号：NCT01314768）。然而，本部分代表观察性数据，不是治疗试验。
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