Bernstein Cheryl, Gillman Andrea G, Zhang Di, Bartman Anna E, Jeong Jong-Hyeon, Wasan Ajay D
Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Division of Biometrics VII, Center for Drug Evaluation and Research, U.S. Food and Drug Administration.
Pain Med. 2020 Dec 25;21(12):3574-3584. doi: 10.1093/pm/pnaa203.
High-quality chronic pain care emphasizes multimodal treatments that include medication and nonpharmacological treatments. But it is not clear which patients will participate in nonpharmacological treatments, such as physical therapy or mental health care, and previous research has shown conflicting evidence.
We used the Patient Outcomes Repository for Treatment (PORT) registry, which combines patient-reported outcomes data with electronic medical records. In this retrospective observational study, we performed two separate multinomial regression analyses with feature selection to identify PORT variables that were predictive of 1) recommendation of a nonpharmacological treatment by the provider and 2) patient participation in nonpharmacological treatments. Two hundred thirty-six patients were recommended (REC) or not recommended (NO REC) a nonpharmacological treatment, and all REC patients were classified as participating (YES) or not participating (NO) in the recommendations.
Female gender and a diagnosis of Z79 "Opioid drug therapy" were significant positive and negative predictors of nonpharmacological treatment recommendations, respectively. Schedule II opioid use at initial presentation and recommendations for rehabilitation therapy were significant predictors of nonparticipation.
Patients using opioids are less likely to be recommended nonpharmacological treatments as part of multimodal chronic pain care and are less likely to participate in nonpharmacological treatments once recommended. Males are also less likely to be recommended nonpharmacological treatments. Patients referred for rehabilitation therapies are less likely to comply with those recommendations. We have identified patients in vulnerable subgroups who may require additional resources and/or encouragement to comply with multimodal chronic pain treatment recommendations.
高质量的慢性疼痛护理强调多模式治疗，包括药物治疗和非药物治疗。但尚不清楚哪些患者会接受非药物治疗，如物理治疗或心理治疗，而且以往的研究证据相互矛盾。
我们使用了治疗患者结果数据库（PORT）登记处的数据，该数据库将患者报告的结果数据与电子病历相结合。在这项回顾性观察研究中，我们进行了两项单独的多项回归分析，并进行特征选择，以确定PORT变量，这些变量可预测：1）提供者推荐非药物治疗；2）患者接受非药物治疗。236名患者被推荐（REC）或未被推荐（NO REC）接受非药物治疗，所有被推荐的患者被分类为接受（YES）或未接受（NO）推荐的治疗。
女性和诊断为Z79“阿片类药物治疗”分别是接受非药物治疗推荐的显著正向和负向预测因素。初次就诊时使用II类阿片药物以及康复治疗建议是不接受治疗的显著预测因素。
使用阿片类药物的患者作为多模式慢性疼痛护理一部分而被推荐接受非药物治疗的可能性较小，并且一旦被推荐，参与非药物治疗的可能性也较小。男性被推荐接受非药物治疗的可能性也较小。被转介接受康复治疗的患者遵守这些建议的可能性较小。我们已经确定了可能需要额外资源和/或鼓励以遵守多模式慢性疼痛治疗建议的脆弱亚组患者。
