Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
Pain Pract. 2020 Jul;20(6):588-599. doi: 10.1111/papr.12883. Epub 2020 Apr 8.
This study aimed to identify characteristics of individuals who are most likely to benefit from long-term opioid therapy in terms of reduction in pain severity and improved mental health-related quality of life (mQoL) without considering potential risks.
This was a retrospective cohort study of 116 patients (age = 51.3 ± 12.5 years, male = 42.2%) enrolled in the Quebec Pain Registry between 2008 and 2011 and who initiated opioid therapy after their first appointment in a multidisciplinary pain clinic and persisted with this treatment for at least 12 months. Clinically significant improvement was defined as a 2-point decrease on the PEG (pain, enjoyment of life, and general activity) Scale of pain severity (scored from 0 to 10) at 12-month follow-up and a 10-point increase on the Short-Form-12 Health Survey version 2 (SF12-v2) Mental Health-Related Quality of Life Summary Scale, which corresponds to 1 standard deviation (SD) of the mean in the general population (mean = 50, SD = 10).
Clinically significant reduction in pain severity was observed in 26.7% of patients, while improvement in mQoL was reported by 20.2% of patients on long-term opioid therapy. Older age (odds ratio [OR] = 1.04; 95% confidence interval [CI]: 1.0 to 1.08; P = 0.032) and alcohol or drug problems (OR = 0.26; 95% CI: 0.07 to 0.96; P = 0.044) were weakly associated with pain severity at 12-month follow-up. Baseline higher pain severity (OR = 0.62; 95% CI: 0.43 to 0.91; P = 0.014) and baseline higher mQoL (OR = 0.89; 95% CI: 0.83 to 0.95; P = 0.001) were associated with non-improvement in mQoL.
The analysis failed to identify clinically meaningful predictors of opioid therapy effectiveness, making it difficult to inform clinicians about which patients with chronic non-cancer pain are most likely to benefit from long-term opioid therapy.
本研究旨在确定在减轻疼痛严重程度和改善心理健康相关生活质量（mQoL）方面，哪些患者最有可能从长期阿片类药物治疗中获益，而不考虑潜在风险。
这是一项回顾性队列研究，纳入了 2008 年至 2011 年期间在魁北克疼痛登记处登记的 116 名患者（年龄=51.3±12.5 岁，男性=42.2%），这些患者在多学科疼痛诊所首次就诊后开始接受阿片类药物治疗，并至少持续治疗 12 个月。临床显著改善定义为 12 个月随访时 PEG（疼痛、享受生活和一般活动）量表疼痛严重程度评分降低 2 分（评分范围为 0 至 10），以及 SF12-v2 心理健康相关生活质量综合量表评分增加 10 分，这相当于一般人群平均分数（平均=50，标准差=10）的 1 个标准差。
26.7%的患者疼痛严重程度得到临床显著缓解，20.2%的患者长期接受阿片类药物治疗后 mQoL 得到改善。年龄较大（优势比[OR]=1.04；95%置信区间[CI]：1.0 至 1.08；P=0.032）和酒精或药物问题（OR=0.26；95%CI：0.07 至 0.96；P=0.044）与 12 个月时的疼痛严重程度弱相关。基线时较高的疼痛严重程度（OR=0.62；95%CI：0.43 至 0.91；P=0.014）和基线时较高的 mQoL（OR=0.89；95%CI：0.83 至 0.95；P=0.001）与 mQoL 无改善相关。
该分析未能确定阿片类药物治疗有效性的有意义的临床预测因素，因此难以告知临床医生哪些慢性非癌性疼痛患者最有可能从长期阿片类药物治疗中获益。
