Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Popul Health Manag. 2019 Dec;22(6):503-510. doi: 10.1089/pop.2018.0210. Epub 2019 Mar 11.
Among chronic low back pain (CLBP) patients, workers' compensation is associated with longer term prescription opioid analgesic use (OAU). The aim was to study the association between receiving Social Security Disability Insurance (SSDI) benefits and course of OAU. This prospective cohort study utilized data from primary care patients diagnosed with non-cancer CLBP. The outcomes were morphine equivalent dose (MED) - categorized as no OAU, 1-50mg MED, or >50mg MED - and change in MED over time using mixed multinomial logistic regression models. Covariates included sociodemographics, pain severity, pain management characteristics, continuity of care with their physician, health-related quality of life, number of comorbid health conditions, obesity, depression, and anxiety. In adjusted analysis, SSDI vs. non-SSDI patients were more likely to be receiving >50mg MED vs. no OAU at baseline (OR = 10.19; 95% CI:1.51-68.83). Differences in OAU trajectory between SSDI groups were nonsignificant ( = 0.204). Collection of SSDI benefits was an independent predictor of higher MED at baseline and persistently higher MED during 2 years of follow-up. Providers should consider the risk of persistent, high-dose opioid use in patients receiving SSDI benefits.
在慢性腰痛（CLBP）患者中，工人赔偿与长期处方类阿片类药物使用（OAU）有关。本研究旨在研究接受社会保障残疾保险（SSDI）福利与 OAU 疗程之间的关联。这项前瞻性队列研究利用了初级保健患者中诊断为非癌症 CLBP 的数据。结果是根据吗啡等效剂量（MED）进行分类，分为无 OAU、1-50mg MED 或 >50mg MED，以及使用混合多项逻辑回归模型随时间变化的 MED 变化。协变量包括社会人口统计学、疼痛严重程度、疼痛管理特征、与医生的连续护理、健康相关的生活质量、合并健康状况的数量、肥胖、抑郁和焦虑。在调整分析中，与非 SSDI 患者相比，SSDI 患者在基线时更有可能接受 >50mg MED 而不是无 OAU（OR=10.19；95%CI：1.51-68.83）。SSDI 组之间 OAU 轨迹的差异无统计学意义（ = 0.204）。SSDI 福利的领取是基线 MED 较高和 2 年随访期间 MED 持续较高的独立预测因素。提供者应考虑在接受 SSDI 福利的患者中持续使用高剂量阿片类药物的风险。
