Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
Drug Alcohol Depend. 2020 Apr 1;209:107902. doi: 10.1016/j.drugalcdep.2020.107902. Epub 2020 Feb 11.
Chronic non-cancer pain (CNCP) among patients with substance use disorder (SUD) poses a risk for worse treatment outcomes. Understanding the association of CNCP with SUD is important for informing the need and potential benefits of pain assessment/management among those with SUDs.
We analyzed electronic health record data from 2013 to 2018 among adults aged ≥18 years (N = 951,533; mean age: 48.4 years; 57.4 % female) in a large academic healthcare system. Adjusted logistic regression models were conducted to estimate the association of CNCP conditions with opioid overdose, emergency department utilization, and inpatient hospitalization stratified by different SUD diagnoses and by gender.
Among the total sample, the prevalence of CNCP was 46.6 % and any SUD was 11.2 %. The majority of patients with a SUD had CNCP (opioid: 74.7 %; sedative: 72.3 %; cannabis: 64.3 %; alcohol: 58.7 %; tobacco: 59.5 %). The prevalence of CNCP was greater in females vs. males for most SUD diagnoses. The presence of CNCP was associated with more mental health disorders and chronic medical conditions among each SUD group. CNCP was associated with significantly decreased odds of overdose among those with opioid use disorder but increased odds of overdose and healthcare utilization among other SUDs. CNCP was positively associated with overdose in females, but not males, with alcohol or non-opioid drug use disorders.
The direction and magnitude of the association between CNCP and negative health indicators differed as a function of SUD type and gender, respectively. Greater awareness of potential unmet pain treatment need may have implications for improving SUD outcomes.
患有物质使用障碍（SUD）的患者的慢性非癌症疼痛（CNCP）会增加治疗效果不佳的风险。了解 CNCP 与 SUD 的关联对于了解 SUD 患者进行疼痛评估/管理的必要性和潜在益处很重要。
我们分析了 2013 年至 2018 年期间，在一个大型学术医疗保健系统中年龄≥18 岁（N=951,533；平均年龄：48.4 岁；57.4%为女性）成年人的电子健康记录数据。采用调整后的逻辑回归模型，按不同的 SUD 诊断和性别分层，估计 CNCP 与阿片类药物过量、急诊就诊和住院治疗的相关性。
在总样本中，CNCP 的患病率为 46.6%，任何 SUD 的患病率为 11.2%。大多数患有 SUD 的患者患有 CNCP（阿片类药物：74.7%；镇静剂：72.3%；大麻：64.3%；酒精：58.7%；烟草：59.5%）。大多数 SUD 诊断中，女性的 CNCP 患病率高于男性。每个 SUD 组中，CNCP 与更多的精神健康障碍和慢性疾病相关。CNCP 与阿片类药物使用障碍患者的药物过量风险显著降低相关，但与其他 SUD 患者的药物过量和医疗保健利用相关。CNCP 与女性的酒精或非阿片类药物使用障碍者的药物过量风险呈正相关，但与男性无关。
CNCP 与负面健康指标之间的关联方向和程度分别取决于 SUD 类型和性别。提高对潜在未满足的疼痛治疗需求的认识可能对改善 SUD 结局具有重要意义。
