Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Urban Life Building, 140 Decatur Street, Suite 434, Atlanta, GA, 30303, USA.
Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, USA.
BMC Psychiatry. 2020 Jan 31;20(1):40. doi: 10.1186/s12888-020-2456-1.
Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia.
Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N = 65,750), BD (N = 38,117) or schizophrenia or schizoaffective disorder (N = 12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses.
Multivariable models indicated that having a MDD (OR = 1.90; 95% CI = 1.85-1.95) or BD (OR = 1.71; 95% CI = 1.66-1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR = 0.86; 95% CI = 0.82-0.90). Having a MDD (OR = 2.59; 95% CI = 2.44-2.75) or BD (OR = 2.12; 95% CI = 1.97-2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications.
Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients. Future research is needed to evaluate the effectiveness of involving mental health clinicians in these efforts.
患有重度抑郁症（MDD）和双相情感障碍（BD）的个体慢性非癌性疼痛（CNCP）的发生率特别高，并且更有可能因疼痛而开具处方类阿片药物。然而，迄今为止，尚无已知的研究专门检查精神分裂症患者的阿片类药物治疗模式。
利用 13 个心理健康研究网络站点的电子病历数据，确定了 MDD（N=65750）、BD（N=38117）或精神分裂症或分裂情感障碍（N=12916）的诊断个体，并按年龄、性别和医疗保险状况与无记录精神疾病的对照进行匹配。提取匹配样本的 CNCP 诊断和处方类阿片药物配药情况。采用多变量分析评估（1）与匹配对照相比，单独的精神疾病诊断类别中，获得疼痛相关诊断的可能性，以及（2）获得阿片类药物的可能性，控制了年龄、性别、医疗保险状况、种族/族裔、收入、合并症、医疗保健使用情况和慢性疼痛诊断。
多变量模型表明，在控制年龄、性别、种族、收入、合并症和医疗保健使用情况后，患有 MDD（OR=1.90；95%CI=1.85-1.95）或 BD（OR=1.71；95%CI=1.66-1.77）诊断与获得 CNCP 诊断的可能性增加有关。相比之下，患有精神分裂症的诊断与获得慢性疼痛诊断的可能性降低有关（OR=0.86；95%CI=0.82-0.90）。患有 MDD（OR=2.59；95%CI=2.44-2.75）或 BD（OR=2.12；95%CI=1.97-2.28）诊断与获得慢性阿片类药物的可能性增加有关，即使在控制了年龄、性别、种族、收入、合并症、医疗保健使用情况和慢性疼痛诊断后也是如此；患有精神分裂症的诊断与获得慢性阿片类药物无关。
患有严重精神疾病的个体，即最有可能出现阿片类药物相关问题的人群，继续比没有精神疾病的同龄人更常被开具阿片类药物。精神卫生临床医生可能特别适合领导这些患者的疼痛评估和管理工作。需要进一步研究来评估让精神卫生临床医生参与这些努力的效果。
