Barry Arden R, Chris Chantal E
Lower Mainland Pharmacy Services (Barry), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.
Chilliwack General Hospital and Chilliwack/Agassiz Palliative Care Program (Chris), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.
Can Pharm J (Ott). 2019 Dec 4;153(1):52-58. doi: 10.1177/1715163519887766. eCollection 2020 Jan-Feb.
This study sought to characterize the real-world treatment of chronic noncancer pain (CNCP) in patients on opioid therapy in primary care.
A retrospective cohort study from 2014-18 was conducted at a multidisciplinary primary care clinic in Chilliwack, British Columbia. Included were adults on daily opioid therapy for CNCP. Patients receiving palliative care or ≤1 visit were excluded. Outcomes of interest included use of opioid/nonopioid pharmacotherapy, number/frequency of visits and proportion of patients able to reduce/discontinue opioid therapy.
Seventy patients (mean age 53 years, 53% male, 51% back pain) were included. Median follow-up was 6 visits over 12 months. Sixty-two patients (89%) reduced their opioid dose, 6 patients had no change and 2 patients required a dose increase. Mean opioid dose was reduced from 183 to 70 mg morphine equivalents daily. Twenty-four patients (34%) discontinued opioid therapy, 6 patients (9%) transitioned to opioid agonist therapy and 6 patients (9%) breached their opioid treatment agreement. Nonopioid pharmacotherapy included nonsteroidal anti-inflammatory drugs (64%), gabapentinoids (63%), tricyclic antidepressants (56%) and nabilone (51%).
Over half of patients were no longer on opioid therapy by the end of the study. Most patients had a disorder (e.g., back pain) for which opioids are generally not recommended. Overall mean opioid dose was reduced from baseline by approximately 60% over 1 year. Lack of access to specialized pain treatments may have accounted for high nonopioid pharmacotherapy usage.
This study demonstrates that treatment of CNCP and opioid tapering can successfully be achieved in a primary care setting. 2020;153:xx-xx.
本研究旨在描述初级保健中接受阿片类药物治疗的慢性非癌性疼痛（CNCP）患者的实际治疗情况。
2014年至2018年在不列颠哥伦比亚省奇利瓦克的一家多学科初级保健诊所进行了一项回顾性队列研究。纳入对象为接受每日阿片类药物治疗CNCP的成年人。接受姑息治疗或就诊次数≤1次的患者被排除。感兴趣的结局包括阿片类/非阿片类药物治疗的使用情况、就诊次数/频率以及能够减少/停用阿片类药物治疗的患者比例。
纳入70例患者（平均年龄53岁，53%为男性，51%有背痛）。中位随访时间为12个月内6次就诊。62例患者（89%）减少了阿片类药物剂量，6例患者无变化，2例患者需要增加剂量。阿片类药物平均剂量从每日183毫克吗啡当量降至70毫克。24例患者（34%）停用了阿片类药物治疗，6例患者（9%）转为阿片类激动剂治疗，6例患者（9%）违反了阿片类药物治疗协议。非阿片类药物治疗包括非甾体抗炎药（64%）、加巴喷丁类药物（63%）、三环类抗抑郁药（56%）和纳布啡（51%）。
到研究结束时，超过一半的患者不再接受阿片类药物治疗。大多数患者患有一般不推荐使用阿片类药物的疾病（如背痛）。总体阿片类药物平均剂量在1年内从基线水平降低了约60%。无法获得专门的疼痛治疗可能是导致非阿片类药物治疗使用率高的原因。
本研究表明，在初级保健环境中可以成功实现CNCP的治疗和阿片类药物减量。2020；153：xx - xx。
