Pierce Derek P R, Pierce Brett, Cheng Chin-I, Perzhinsky Juliette
Central Michigan University (CMU) College of Medicine, Mt. Pleasant, MI.
Florida Hospital for Children, Orlando, FL.
Medicine (Baltimore). 2019 Apr;98(15):e15128. doi: 10.1097/MD.0000000000015128.
The purpose of this study is to examine the treatment of noncancer musculoskeletal pain in different clinical settings by assessing patient demographics, pain diagnoses, opioid analgesic monitoring, and alternative treatments.Data was collected in a retrospective chart review involving 300 randomly selected charts with an active musculoskeletal diagnosis based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes. The population consisted of primary care outpatient clinic and emergency department encounters during the timeframe of January 1, 2016 to March 31, 2016 in a predominantly rural community in Michigan. Variables included prescription medications, musculoskeletal conditions, and prescription drug monitoring modalities. Statistical analysis was accomplished using means, standard deviations, proportions, 2-sample proportional tests, multivariable logistic regression, and multinomial regression models.Opioid prescribing was observed in 64% of outpatient and 68.9% of emergency department encounters. Back pain was the most common problem with 61.9% patients prescribed opioids having at least 1 diagnosis of back pain. Patients on opioids were older (mean age 58) than patients taking nonopioids (mean age 50). For every year of increasing age, there is a 3.1% increase in the odds of an opioid being prescribed (odds ratio 1.03, confidence interval 1.012-1.049, P = .001). Documentation was extremely low with only 15.2%, 1.5%, and 1.5% of patient charts prescribed opioids demonstrating documentation of urine drug screens, pain agreements, and review of a state prescription drug monitoring program, respectively.Despite drug monitoring recommendations, low rates of monitoring were observed. Back pain was the largest contributing pain location and had higher opioid use compared to other sites. Many patients had additional pain medications being concurrently prescribed with opioids suggesting that musculoskeletal pain is not often controlled by a single medication type. Reported alcohol abuse, active tobacco use, and illicit substance use can serve as predictors when assessing patients for pain management options. The use of alternative measures and integrative treatment modalities (which saw low utilization in this study) should be implemented as either primary or supplementary therapy as a way to reduce the pharmacologic burden on the patient.
本研究的目的是通过评估患者人口统计学特征、疼痛诊断、阿片类镇痛药监测及替代治疗，来研究不同临床环境下非癌性肌肉骨骼疼痛的治疗情况。数据收集于一项回顾性病历审查，涉及300份随机选取的病历，这些病历基于《国际疾病和相关健康问题统计分类》第10版编码有活跃的肌肉骨骼诊断。研究人群包括2016年1月1日至2016年3月31日期间密歇根州一个主要为农村社区的初级保健门诊和急诊科就诊患者。变量包括处方药、肌肉骨骼疾病及处方药监测方式。统计分析采用均值、标准差、比例、双样本比例检验、多变量逻辑回归和多项回归模型。
在64%的门诊患者和68.9%的急诊科就诊患者中观察到了阿片类药物处方。背痛是最常见的问题，61.9%开具阿片类药物的患者至少有1次背痛诊断。使用阿片类药物的患者比使用非阿片类药物的患者年龄更大（平均年龄58岁对50岁）。年龄每增加一岁，开具阿片类药物的几率增加3.1%（比值比1.03，置信区间1.012 - 1.049，P = 0.001）。记录极低，分别只有15.2%、1.5%和1.5%开具阿片类药物的患者病历显示有尿液药物筛查、疼痛协议及州处方药监测项目审查的记录。
尽管有药物监测建议，但监测率较低。背痛是导致用药的最大疼痛部位，与其他部位相比阿片类药物使用量更高。许多患者同时还开具了其他止痛药物，这表明肌肉骨骼疼痛通常并非由单一药物类型控制。报告的酗酒、当前吸烟及非法药物使用情况在评估患者疼痛管理方案时可作为预测因素。应采用替代措施和综合治疗方式（本研究中使用率较低）作为主要或辅助治疗，以减轻患者的药物负担。
