Greene Charlotte, Pearson Alice
King's College London, GKT School of Medicine.
Br J Gen Pract. 2020 Jun;70(suppl 1). doi: 10.3399/bjgp20X711581.
Opioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.
An audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.
A search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine's best-practice guidelines were used.
Demographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids.
back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented.
56% 4-week, 70% past year.
Opioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.
阿片类药物是治疗急性和姑息性疼痛的有效镇痛药，但尚无长期缓解疼痛的循证依据。它们还存在相当大的风险，如过量用药和成瘾。尽管如此，它们在慢性疼痛治疗中的处方量却日益增加。在英国，1998年至2018年间阿片类药物的处方量增加了一倍多。
对班霍尔姆全科医疗诊所进行一次审计，以了解高强度阿片类药物的处方规模。审计的目的是查明初始咨询和复诊过程中的用药指征、处方时长、讨论情况及记录是否符合最佳实践指南。
在苏格兰治疗药物数据库中搜索2019年7月1日至2019年10月1日期间平均每日阿片类药物等效剂量≥50毫克吗啡的患者，排除美沙酮、癌症疼痛或姑息性处方。采用了疼痛医学学院的最佳实践指南。
人口统计学特征：60名患者（37名女性），平均年龄62岁，28%登记有重复阿片类药物处方，38%合并抑郁症。处方时长：平均6年，57%超过5年，22%超过10年。阿片类药物：52%为曲马多，23%同时使用两种阿片类药物。
背痛（42%）、骨关节炎（12%）、纤维肌痛（10%）。初始咨询：7%商定了治疗结果，35%记录了随访情况。
56%为4周复诊，70%在过去一年进行过复诊。
未遵循阿片类药物处方指南。存在的重大问题包括：慢性疼痛的长期处方尤其是背痛；新患者登记重复处方；未商定治疗结果，关键信息是目标是疼痛管理而非缓解疼痛。该诊所已采取了一些改变措施：发放患者信息单，对新使用阿片类药物的患者进行强制性1个月复诊，以及在手术中进行疼痛转诊。
