Morasco Benjamin J, Smith Ning, Dobscha Steven K, Deyo Richard A, Hyde Stephanie, Yarborough Bobbi Jo H
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States.
Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.
Pain. 2020 Jun;161(6):1332-1340. doi: 10.1097/j.pain.0000000000001817.
The use of long-term opioid therapy for chronic pain remains common, yet data on long-term outcomes, especially after dose escalation, are sparse. This study examined potential benefits and harms associated with prescription opioid dose escalation. Participants from 2 institutions were enrolled in a 2-year prospective cohort study. All participants (n = 517) had a musculoskeletal pain diagnosis and were receiving a stable dose of long-term opioid therapy at baseline. Participants completed self-report measures of pain, disability, depression, and potential adverse effects at baseline and every 6 months for 2 years. We reviewed electronic health record data weekly to identify episodes of prescription opioid dose escalation; participants who had increases in their dose were seen for additional research visits within 1 month of dose escalation. Over 2 years, 19.5% of participants had prescription opioid dose increases. After controlling for covariates, there were no significant changes on any variable after dose escalation. Of those with a dose increase, 3% experienced a clinically meaningful improvement in pain after dose escalation. Participants in the entire sample had small improvements in pain intensity, depressive symptoms, medication-related side effects, and lower risk for prescription opioid misuse during the study period. Sexual functioning worsened over time. There were no significant changes in the full sample on pain disability, sleep functioning, or experiencing a fall. In summary, patients prescribed stable doses of long-term opioid therapy may demonstrate small changes in key pain-related outcomes over time, but prescription opioid dose escalation status is unrelated to clinical outcomes.
长期使用阿片类药物治疗慢性疼痛仍然很常见，但关于长期疗效的数据，尤其是剂量增加后的疗效数据却很少。本研究调查了与处方阿片类药物剂量增加相关的潜在益处和危害。来自2家机构的参与者被纳入一项为期2年的前瞻性队列研究。所有参与者（n = 517）均被诊断为肌肉骨骼疼痛，且在基线时接受稳定剂量的长期阿片类药物治疗。参与者在基线时以及之后的2年中每6个月完成一次关于疼痛、残疾、抑郁和潜在不良反应的自我报告测量。我们每周审查电子健康记录数据，以确定处方阿片类药物剂量增加的情况；剂量增加的参与者在剂量增加后1个月内接受额外的研究访视。在2年时间里，19.5%的参与者出现了处方阿片类药物剂量增加。在控制协变量后，剂量增加后任何变量均无显著变化。在剂量增加的参与者中，3%在剂量增加后疼痛有临床上有意义的改善。在研究期间，整个样本中的参与者在疼痛强度、抑郁症状、药物相关副作用方面有小幅改善，处方阿片类药物滥用风险降低。性功能随时间恶化。在整个样本中，疼痛残疾、睡眠功能或跌倒情况没有显著变化。总之，接受稳定剂量长期阿片类药物治疗的患者随着时间推移可能在关键疼痛相关结局方面有小幅变化，但处方阿片类药物剂量增加情况与临床结局无关。
