阿片类药物流行：风湿病学实践是否会给患者带来风险？对风湿病学家开具阿片类药物处方和遵守强阿片类药物处方指南情况的全国性调查。

Opioid epidemic: Does rheumatological practice favors risk for patients? National survey on rheumatologists' opioid prescriptions and compliance to guidelines for strong opioid prescription.

机构信息

Centre d'évaluation et traitement de la douleur, hôpital Cochin; INSERM U987; Université Paris Descartes, 75014, Paris, France.

Université de Clermont Auvergne, CHU de Clermont-Ferrand, Inserm, Pharmacologie médicale/Centre Evaluation et Traitement de la Douleur, Observatoire français des Médicaments Antalgiques, Institut Analgesia, 63001, Clermont-Ferrand, France.

出版信息

Joint Bone Spine. 2021 Jan;88(1):105046. doi: 10.1016/j.jbspin.2020.06.019. Epub 2020 Jul 9.

DOI:10.1016/j.jbspin.2020.06.019

PMID:32653655

Abstract

OBJECTIVES

Given the scope of rheumatology and its prevalence of pain, it seems needed that a study should focus on prescription habits, in the midst of the international opioid epidemic and given the moderate efficacy of strong opioids in chronic musculoskeletal conditions. We compared rheumatologists' opioid prescribing patterns in non-cancer pain with recommended practice.

METHODS

We performed a cross-sectional study of the French health insurance database, including all patients aged 16 years or over reimbursed for at least one strong opioid prescription from a rheumatologist in 2015. A nationwide survey of all registered rheumatologists in France was performed with a 47-item questionnaire in June 2015.

RESULTS

Only 2.4% of the patients receiving a strong opioid in 2015 (n=700,946) had at least one prescription from a rheumatologist. Rheumatologists prescribed mostly morphine, and significantly less oxycodone and fentanyl (P<0.00001) than other specialists. Rheumatologists prescribed a mean of 35.8mg morphine equivalent/day. A response rate of 33.7% was obtained to the questionnaire. Acute musculoskeletal pain was the principal condition for strong opioids prescription, with 94.5% re-evaluating opioid treatment within two weeks of initiation. For efficacy, 80% said that they stopped treatment if no benefit was observed after a test period (mean=1.2 months). Rheumatologists with pain management training were significantly more likely to evaluate pain before prescribing strong opioids (P=0.001), evaluate efficacy within three months (P=0.01) and screen for risk factors for misuse at initiation (P<0.0001).

CONCLUSIONS

For non-cancer pain, rheumatologists generally prescribe opioids for short periods, at low doses, mostly according to national recommendations. Pain education strongly affected opioid prescription by rheumatologists.

摘要

目的

鉴于风湿病学的范围及其疼痛的普遍性，似乎有必要进行一项研究，重点关注在国际阿片类药物流行和慢性肌肉骨骼疾病中强阿片类药物疗效中等的情况下，处方习惯。我们比较了风湿病学家在非癌性疼痛中的阿片类药物处方模式与推荐实践。

方法

我们对法国健康保险数据库进行了横断面研究，该数据库包括 2015 年因至少一种强阿片类药物处方而从风湿病学家处获得报销的所有 16 岁及以上的患者。2015 年 6 月，对法国所有注册风湿病学家进行了一项全国性的 47 项问卷调查。

结果

2015 年接受强阿片类药物治疗的患者中（n=700946），只有 2.4%至少有一位风湿病学家开具了处方。风湿病学家主要开具吗啡，而开具羟考酮和芬太尼的比例明显较低（P<0.00001）。风湿病学家开具的平均吗啡等效日剂量为 35.8mg。对问卷的回复率为 33.7%。急性肌肉骨骼疼痛是开具强阿片类药物处方的主要原因，94.5%的患者在开始治疗后两周内重新评估阿片类药物治疗。对于疗效，80%的医生表示，如果在试验期间（平均 1.2 个月）没有观察到获益，他们会停止治疗。接受过疼痛管理培训的风湿病学家在开具强阿片类药物之前评估疼痛的可能性显著更高（P=0.001），在三个月内评估疗效的可能性更高（P=0.01），并在开始时筛查滥用风险因素的可能性更高（P<0.0001）。