J Am Pharm Assoc (2003). 2019 Sep-Oct;59(5):691-697. doi: 10.1016/j.japh.2019.06.009. Epub 2019 Jul 18.
Multimodal and multidomain strategies are currently recommended for the management of chronic pain. However, there is little information available on how individuals (opioid users versus nonusers) with chronic pain use multimodal strategies in pain management.
This cross-sectional study used questionnaire data from a sample of pharmacists with chronic pain. The questionnaire collected data on demographics, pain characteristics, pain management strategies, and pain management outcomes. The association between the number of strategies used and opioid use were evaluated by linear regression. Differences between the groups in nonsteroidal anti-inflammatory drugs (NSAIDs) use and types of strategies used in managing the pain were analyzed using logistic regressions. A hierarchical logistic regression was performed to identify potential predictors differentiating opioid users from nonusers.
Fifty-seven opioid users and 100 nonusers with chronic pain completed the questionnaire. Opioid users reported higher levels of pain at baseline (7.6 ± 1.7 vs. 6.7 ± 2.2; P = 0.011); however, pain levels after treatment were comparable (2.9 ± 1.9 vs. 3.2 ± 2.4; P = 0.33). Although there was no significant difference in the total number of strategies, the number of pharmacologic strategies was significantly higher in opioid users (P = 0.007). The type of pain management strategies and the use of NSAIDs were similar in both groups after adjusting for potential confounders. The significant predictors of opioid use from hierarchical logistic regression analysis were: lower use of over-the-counter NSAIDs (odds ratio [OR] 0.4; 95% CI 0.2-0.9), using more interventions (OR 1.2; 95% CI 1.1-1.3), reliance on pharmacologic strategies (OR 10.8; 95% CI 2.1-55.7), using combination of pharmacologic and nonpharmacologic strategies (OR 3.7; 95% CI 0.9-15.8), and less interference with daily activities after treatment (OR 0.2; 95% CI 0.1-0.9).
Opioid use was primarily related to the use of prescription pharmacologic strategies, but not to age or gender. Posttreatment pain levels were similar between opioid users and nonusers; however, opioid users used more nonopioid medications than nonusers did.
目前推荐采用多模式和多领域策略来管理慢性疼痛。然而，对于患有慢性疼痛的个体（阿片类药物使用者与非使用者）如何在疼痛管理中使用多模式策略，相关信息有限。
本横断面研究使用了一组患有慢性疼痛的药剂师的问卷调查数据。问卷收集了人口统计学、疼痛特征、疼痛管理策略和疼痛管理结果的数据。采用线性回归评估使用的策略数量与阿片类药物使用之间的关联。使用逻辑回归分析了两组之间非甾体抗炎药（NSAIDs）使用和用于管理疼痛的策略类型的差异。采用分层逻辑回归确定区分阿片类药物使用者和非使用者的潜在预测因素。
57 名阿片类药物使用者和 100 名患有慢性疼痛的非阿片类药物使用者完成了问卷调查。阿片类药物使用者报告基线时疼痛程度更高（7.6 ± 1.7 与 6.7 ± 2.2；P = 0.011）；然而，治疗后的疼痛水平相当（2.9 ± 1.9 与 3.2 ± 2.4；P = 0.33）。尽管在使用的策略总数上没有显著差异，但阿片类药物使用者使用的药物治疗策略数量明显更多（P = 0.007）。在调整潜在混杂因素后，两组的疼痛管理策略类型和 NSAIDs 使用情况相似。分层逻辑回归分析的阿片类药物使用的显著预测因素为：非处方 NSAIDs 使用量较低（比值比 [OR] 0.4；95%置信区间 [CI] 0.2-0.9）、使用更多干预措施（OR 1.2；95% CI 1.1-1.3）、依赖药物治疗策略（OR 10.8；95% CI 2.1-55.7）、采用药物和非药物治疗策略相结合（OR 3.7；95% CI 0.9-15.8）和治疗后对日常活动的干扰较小（OR 0.2；95% CI 0.1-0.9）。
阿片类药物的使用主要与处方药物治疗策略的使用有关，而与年龄或性别无关。阿片类药物使用者和非使用者治疗后的疼痛水平相似；然而，阿片类药物使用者比非使用者使用了更多的非阿片类药物。
