Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Norwegian Advisory Unit on Complex Symptom Disorders, St. Olav University Hospital, Trondheim, Norway.
Pain. 2020 May;161(5):1083-1091. doi: 10.1097/j.pain.0000000000001800.
Increasing numbers survive cancers in childhood and adolescence. Long-term survivors of cancers in adulthood have increased prevalence of pain and consumption of analgesics. It is not established whether long-term survivors of cancers in childhood and adolescence also have an increased use of analgesics. However, based on increased use of antidepressants and anxiolytics in long-term survivors of cancers in childhood and adolescence, we hypothesized that this group also had increased use of analgesics. Based on data from the 2 nationwide registers, the Cancer Registry of Norway and the Norwegian Prescription Database, a cohort of 5585 (52% males) long-term survivors of cancers in childhood, adolescence, and early adult life was established. Age- and sex-adjusted comparisons were made to the general population. The age-adjusted one-year periodic prevalence of receiving prescriptions of opioids, benzodiazepines, and benzodiazepine-related hypnotics in the study population was increased by 20% to 50%, and the one-year periodic prevalence of receiving prescriptions of gabapentinoids was approximately increased 2-fold compared to the general population. For paracetamol and nonsteroidal anti-inflammatory drugs, no difference was found. For those survivors, who were persistent or high-dose users of opioids, comedication with high doses of benzodiazepines and/or benzodiazepine-related hypnotics was far more common than among persistent and high-dose opioid users in the general population. The high prevalence of gabapentinoids may indicate increased prevalence of neuropathic pain in this group. The high degree of comedication with benzodiazepines and/or benzodiazepine-related hypnotics in survivors on persistent and high-dose opioids might be an indication of problematic opioid use or addiction.
越来越多的儿童和青少年癌症幸存者得以存活。成年癌症幸存者的疼痛和镇痛药消耗普遍增加。目前尚不确定儿童和青少年癌症幸存者是否也会增加镇痛药的使用。然而,基于儿童和青少年癌症幸存者中抗抑郁药和抗焦虑药使用量的增加,我们假设这一群体也增加了镇痛药的使用。根据挪威癌症登记处和挪威处方数据库这两个全国性登记处的数据,建立了一个由 5585 名(52%为男性)儿童、青少年和成年早期癌症长期幸存者组成的队列。对年龄和性别进行了调整,与普通人群进行了比较。研究人群接受阿片类药物、苯二氮䓬类药物和苯二氮䓬类相关催眠药的一年定期患病率增加了 20%至 50%,加巴喷丁类药物的一年定期患病率与普通人群相比大约增加了 2 倍。对于扑热息痛和非甾体抗炎药,未发现差异。对于那些持续或大剂量使用阿片类药物的幸存者,与普通人群中持续和大剂量使用阿片类药物的患者相比,高剂量苯二氮䓬类药物和/或苯二氮䓬类相关催眠药联合用药更为常见。加巴喷丁类药物的高患病率可能表明该群体中神经性疼痛的患病率增加。持续和大剂量使用阿片类药物的幸存者中,苯二氮䓬类药物和/或苯二氮䓬类相关催眠药联合用药的程度很高,这可能表明阿片类药物的使用或成瘾存在问题。