Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mt Sinai, New York, NY.
Department of Anesthesiology Washington University School of Medicine in St. Louis, St. Louis, MO.
Pain Physician. 2019 Jul;22(4):401-411.
Chronic non-cancer pain (CNCP) is a major health concern. Opioids may be a useful treatment option, but their use still remains controversial given the significant risks and epidemic of opioid addiction and abuse. There is limited data on whether opioid therapy is an effective treatment option for chronic non-cancer pain.
To assess both physical and emotional dimensions of health for patients on opioid therapy for CNCP by reviewing the 36-Item Short Form Health Survey (SF-36) .
This study was a retrospective cohort review.
Outpatient pain clinic.
We recruited 182 patients at the West Penn Pain Institute outpatient pain clinic: 94 patients were recruited for the low-dose opioid group (5-30 morphine milligram equivalents [MME]) while 88 patients were recruited for the high-dose opioid group (> 90 MME). Each patient filled out the SF-36 survey used to assess both the physical and emotional dimensions of their health. We also analyzed patients' employment status, reasons for unemployment, pain diagnosis, side effects, and compliance issues through the electronic medical record (EMR).
Mean scores on General Health Perceptions for the low-dose and high-dose opioid groups were 50.3 ± 21.6 and 44.4 ± 21.9, respectively (P = .07). Though not reaching statistical significance, high-dose patients had lower item scores, indicating a perception of poorer health. There were no significant differences between the low-dose and high-dose opioid treatment groups on any of the mean scores from the 8 domains of the SF-36. There was a statistically significant association between opioid treatment group and working status, noncompliance, and the self-reported number of side effects. Patients treated with high-dose opioids had significantly higher rates of unemployment (85%) than did low-dose opioid patients (66%) (x-squared[1] = 8.48, P =.004; odds ratio [OR] = 2.89 [95% confidence interval (CI), 1.39-6.01]). Unemployed patients in the high-dose treatment group were more likely to list disability as unemployment while retirement was the most common response in the low-dose treatment group. Patients treated with high-dose opioids had significantly higher rates of self-reported side effects (46%) than did low-dose opioid patients (21%) (x-squared[1] = 12.02, P =.001; OR = 3.08 [95% CI, 1.61-5.89]). Patients treated with high-dose opioids had significantly higher rates of noncompliance (49%) than did low-dose opioid patients (33%) (x-squared[1] = 4.75, P =.029; OR = 1.94 [95% CI, 1.07-3.54]). Thus, the odds of a high-dose opioid patient being unemployed were 2.89 times greater than the odds for a low-dose opioid patient; the odds of a high-dose opioid patient self-reporting side-effects were 3.08 times greater than the odds for a low-dose opioid patient; and the odds of a high-dose opioid patient being noncompliant with their medications were 1.94 times greater than the odds for a low-dose opioid patient.
The observation al design prohibits drawing causal relationships, and entry criteria was restricted.
These data suggest that patients receiving low-dose and high-dose opioid treatment do not have significantly different quality-of-life outcomes. Future studies that incorporate longitudinal data are necessary to examine the temporal relationship between quality of life and opioid therapy.
Chronic pain, chronic non-cancer pain, opioids, pain, quality of life, side effects, noncompliance, unemployment.
慢性非癌性疼痛（CNCP）是一个主要的健康问题。阿片类药物可能是一种有用的治疗选择，但由于阿片类药物成瘾和滥用的显著风险和流行，其使用仍然存在争议。关于阿片类药物治疗是否是慢性非癌性疼痛的有效治疗选择，数据有限。
通过审查 36 项简短健康调查问卷（SF-36）来评估接受阿片类药物治疗的 CNCP 患者的身体和情感健康维度。
这是一项回顾性队列研究。
门诊疼痛诊所。
我们在西宾夕法尼亚疼痛研究所门诊疼痛诊所招募了 182 名患者：94 名患者被招募到低剂量阿片类药物组（5-30 吗啡毫克当量 [MME]），而 88 名患者被招募到高剂量阿片类药物组（>90 MME）。每位患者填写了 SF-36 调查问卷，用于评估他们的身体和情感健康维度。我们还通过电子病历（EMR）分析了患者的就业状况、失业原因、疼痛诊断、副作用和合规问题。
低剂量和高剂量阿片类药物组的一般健康感知平均得分为 50.3±21.6 和 44.4±21.9，分别（P=0.07）。虽然没有达到统计学意义，但高剂量患者的项目得分较低，表明他们对健康的感知较差。在 SF-36 的 8 个领域中，低剂量和高剂量阿片类药物治疗组之间的平均得分没有显著差异。阿片类药物治疗组与工作状态、不合规和自我报告的副作用数量之间存在统计学显著关联。高剂量阿片类药物治疗组的失业率（85%）明显高于低剂量阿片类药物治疗组（66%）（卡方[1] = 8.48，P=0.004；优势比[OR] = 2.89 [95%置信区间（CI），1.39-6.01]）。高剂量治疗组失业的患者更有可能将残疾列为失业原因，而低剂量治疗组的最常见反应是退休。高剂量阿片类药物治疗组自我报告副作用的发生率（46%）明显高于低剂量阿片类药物治疗组（21%）（卡方[1] = 12.02，P=0.001；OR = 3.08 [95% CI，1.61-5.89]）。高剂量阿片类药物治疗组的不合规率（49%）明显高于低剂量阿片类药物治疗组（33%）（卡方[1] = 4.75，P=0.029；OR = 1.94 [95% CI，1.07-3.54]）。因此，高剂量阿片类药物患者失业的可能性是低剂量阿片类药物患者的 2.89 倍；高剂量阿片类药物患者自我报告副作用的可能性是低剂量阿片类药物患者的 3.08 倍；高剂量阿片类药物患者不遵守药物治疗的可能性是低剂量阿片类药物患者的 1.94 倍。
观察性设计禁止得出因果关系，且纳入标准受到限制。
这些数据表明，接受低剂量和高剂量阿片类药物治疗的患者的生活质量结果没有显著差异。未来需要纳入纵向数据的研究来检查生活质量与阿片类药物治疗之间的时间关系。
慢性疼痛，慢性非癌性疼痛，阿片类药物，疼痛，生活质量，副作用，不合规，失业。
