López-Martínez Alicia E, Reyes-Pérez Ángela, Serrano-Ibáñez Elena Rocío, Esteve Rosa, Ramírez-Maestre Carmen
Facultad de Psicología, Instituto de Investigaciones Biomédicas (IBIMA), Universidad de Málaga, Málaga 29071, Spain.
World J Clin Cases. 2019 Dec 26;7(24):4254-4269. doi: 10.12998/wjcc.v7.i24.4254.
The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder (PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder (OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.
To perform a systematic review on the association between PTSD, chronic non-cancer pain (CNCP), and opioid intake (., prescription, misuse, and abuse).
We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention, Comparator, and Outcomes (PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases: PubMed, MEDLINE, PsycINFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling, confounding variables, and the statistical analysis.
A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men (81.6%). The most common chronic pain condition was musculoskeletal pain: back pain (47.14% across studies; range: 16%-60.6%), arthritis and joint pain (31.1%; range: 18%-67.5%), and neck pain (28.7%; range: 3.6%-63%). In total, 42.4% of the participants across studies had a diagnosis of PTSD (range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.
Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.
文献表明，慢性疼痛与创伤后应激障碍（PTSD）之间存在高度共现性。已发现PTSD与药物滥用之间存在关联。PTSD是一种严重疾病，在开具阿片类药物处方时应予以考虑。研究发现，患有PTSD的慢性疼痛患者中阿片类药物使用障碍（OUD）的患病率高于未患该疾病的患者。
对PTSD、慢性非癌性疼痛（CNCP）和阿片类药物摄入（即处方、误用和滥用）之间的关联进行系统评价。
我们按照系统评价和Meta分析的首选报告项目指南进行了系统评价。在系统评价方案中预先制定了患者、干预措施、对照和结局（PICOS）标准。对PROSPERO数据库进行了检索。2019年3月，还对其他5个数据库进行了检索：PubMed、MEDLINE、PsycINFO、科学网和PILOTS。使用苏格兰跨学院指南网络队列研究清单评估所选研究的方法学质量和偏倚风险。根据每项研究的内部有效性、参与者抽样、混杂变量和统计分析对其进行评估。
共识别出151项潜在符合条件的研究，其中17项被保留用于分析。只有10项符合入选标准。所有研究均发表于2008年至2018年之间，且在美国进行。符合条件的研究共纳入1622785名独特参与者。其中，196516人患有CNCP和PTSD合并症且正在服用阿片类药物。参与者的跨研究平均年龄为35.2岁。大多数参与者为男性（81.6%）。最常见的慢性疼痛情况是肌肉骨骼疼痛：背痛（各研究中占47.14%；范围：16%-60.6%）、关节炎和关节痛（31.1%；范围：18%-67.5%）以及颈部疼痛（28.7%；范围：3.6%-63%）。总体而言，各研究中42.4%的参与者被诊断为PTSD（范围：4.7%-95%）。关于阿片类药物摄入，我们确定了2种不同结局：阿片类药物处方和OUD。所有研究均报告了接受阿片类药物处方的CNCP患者中PTSD患病率更高的证据，且PTSD与CNCP患者的OUD相关。
将阿片类镇痛药物处方作为CNCP患者的首选治疗方法时，应包括对基线PTSD进行筛查，以确保安全使用这些药物。
