Diasso Pernille D K, Sjøgren Per, Højsted Jette, Nielsen Susanne D, Main Katharina M, Kurita Geana P
Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Multidisciplinary Pain Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Scand J Pain. 2019 Jul 26;19(3):533-543. doi: 10.1515/sjpain-2019-0007.
Background and aims Opioid consumption has increased dramatically in patients with chronic non-cancer pain (CNCP), but long-term consequences are still unclear. The aim of this study is to investigate the effects of long-term opioid treatment on pain, cognition, mood, sleep and quality of life in CNCP patients. Methods In this cross-sectional pilot study, two groups of patients with CNCP treated in a multidisciplinary pain center were selected: (1) opioid group: ≥30 mg morphine equivalent/day for >4 weeks, and (2) control group: no opioid consumption for >4 weeks. Socio-demographic data, alcohol consumption, smoking habits and body mass index (BMI) were registered and pain (brief pain inventory), mood (Hospital Anxiety and Depression Scale), sleep (Pittsburgh Sleep Quality Index) and quality of life (RAND 36-Item Health Survey) were assessed. Continuous Reaction Time and the Digit Span Test were used to evaluate cognitive function. Data was analyzed with a Fisher's exact test and Wilcoxon two-sample test. Results Forty-two patients with CNCP were included (21 in each group). No differences regarding socio-demographics, smoking/alcohol habits and duration, type, or intensity of pain were found. More patients in the opioid group had significantly higher BMI (62% above BMI 25 vs. 33.3%, p = 0.042). Consequently, the subsequent data analyses were controlled for BMI. The two groups did not differ in pain, cognition, anxiety, depression, sleep or quality of life but both showed lower values than the normal standards. Further, the opioid group presented a tendency to lower ratings regarding pain and social function and performed below the normal cut off in the continuous reaction time. Conclusions No significant differences between the two groups were found regarding any of the above-mentioned variables. Interestingly, the patients assessed, regardless of taking opioids or not, could be classified with moderate pain intensity, anxiety and low quality of sleep and life compared to norm standards. Implications The findings of this pilot study suggested that long-term opioid treatment may influence pain and quality of life among CNCP patients. A larger cohort is needed to verify these findings.
慢性非癌性疼痛（CNCP）患者的阿片类药物消费量急剧增加，但其长期后果仍不明确。本研究旨在调查长期阿片类药物治疗对CNCP患者疼痛、认知、情绪、睡眠和生活质量的影响。方法：在这项横断面试点研究中，选取了在多学科疼痛中心接受治疗的两组CNCP患者：（1）阿片类药物组：吗啡当量≥30 mg/天，持续时间>4周；（2）对照组：未使用阿片类药物>4周。记录社会人口统计学数据、饮酒量、吸烟习惯和体重指数（BMI），并评估疼痛（简明疼痛量表）、情绪（医院焦虑抑郁量表）、睡眠（匹兹堡睡眠质量指数）和生活质量（兰德36项健康调查）。使用连续反应时间和数字广度测试评估认知功能。数据采用Fisher精确检验和Wilcoxon两样本检验进行分析。结果：纳入42例CNCP患者（每组21例）。在社会人口统计学、吸烟/饮酒习惯以及疼痛的持续时间、类型或强度方面未发现差异。阿片类药物组中更多患者的BMI显著更高（BMI高于25者占62%，而对照组为33.3%，p = 0.042）。因此，后续数据分析对BMI进行了校正。两组在疼痛、认知、焦虑、抑郁、睡眠或生活质量方面无差异，但均低于正常标准。此外，阿片类药物组在疼痛和社会功能评分上有降低趋势，且连续反应时间低于正常临界值。结论：在上述任何变量方面，两组之间均未发现显著差异。有趣的是，与正常标准相比，所评估的患者，无论是否服用阿片类药物，均可归类为中度疼痛强度、焦虑以及睡眠和生活质量较低。意义：这项试点研究的结果表明，长期阿片类药物治疗可能会影响CNCP患者的疼痛和生活质量。需要更大规模的队列研究来验证这些发现。
