Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA.
Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720957438. doi: 10.1177/2150132720957438.
Due to their potentially deleterious effects, minimizing the use of opioids for musculoskeletal pain is a priority for healthcare systems. The objective of this study was to examine the risk of future opioid prescription use based on prior opioid use within a non-surgical cohort with musculoskeletal knee pain. We also examined the risk of pre-existing comorbidities on future opioid use, and the risk of prior opioid use on future comorbidities (sleep, mental health, cardiometabolic disorders).
Data came from the Military Health System Data Repository for 80 290 consecutive beneficiaries with an initial episode of care for patellofemoral pain from January 1, 2010 through December 31, 2011. Risk was calculated using 2 × 2 tables based on pre- and post-opioid utilization and comorbid diagnosis. Risk ratios, relative and absolute risk increases, and numbers needed to harm were calculated, all with 95% confidence intervals.
Prior opioid use resulted in a risk ratio of 18.0 (95 CI 17.1, 19.0) and an absolute risk increase of 61.6% for future opioid use (numbers needed to harm = 2). The presence of all comorbidities (except cardiometabolic syndrome) were associated with a significant relative risk for future opioid use (RR range 1.2-1.5), but the absolute risk increase was trivial (range 0.7%-2.2%). The relative risk for a chronic pain diagnosis, traumatic brain injury/concussion, insomnia, depression, and PTSD were all significantly higher in those with prior opioid use (1.3-1.6), but absolute risk increase was minimal (1.1%-6.5%).
Prior opioid use was a strong risk factor for future opioid use in non-surgical patients with knee pain. These findings show that history of prior opioid use is important when assessing the risk of future opioid use, whereas prior comorbidities may not be as important. Opioid history assessment should be standard practice for all patients with patellofemoral pain in whom an opioid prescription is considered.
由于阿片类药物可能产生有害影响，因此对于医疗保健系统而言，将肌肉骨骼疼痛的阿片类药物使用最小化是当务之急。本研究的目的是根据非手术性膝关节疼痛患者的既往阿片类药物使用情况，检查未来阿片类药物处方使用的风险。我们还检查了先前存在的合并症对未来阿片类药物使用的风险，以及先前使用阿片类药物对未来合并症（睡眠，心理健康，心脏代谢疾病）的风险。
数据来自 2010 年 1 月 1 日至 2011 年 12 月 31 日期间，80290 名连续接受髌股疼痛初始治疗的军人健康系统数据存储库。根据阿片类药物使用前后和合并症诊断情况，使用 2×2 表计算风险。计算风险比，相对和绝对风险增加以及需要伤害的数量，所有结果均具有 95％置信区间。
先前使用阿片类药物会导致未来使用阿片类药物的风险比为 18.0（95％CI 17.1，19.0），绝对风险增加 61.6％（需要伤害的数量= 2）。所有合并症（心脏代谢综合征除外）的存在均与未来阿片类药物使用的相对风险显著相关（RR 范围 1.2-1.5），但绝对风险增加微不足道（范围 0.7％-2.2％）。先前使用阿片类药物与慢性疼痛诊断，创伤性脑损伤/脑震荡，失眠，抑郁和创伤后应激障碍的相对风险均显着升高（1.3-1.6），但绝对风险增加很小（1.1％-6.5％）。
在非手术性膝关节疼痛患者中，先前使用阿片类药物是未来使用阿片类药物的重要危险因素。这些发现表明，在评估未来阿片类药物使用的风险时，既往阿片类药物使用史很重要，而先前的合并症可能并不那么重要。在考虑开具阿片类药物处方时，应对所有髌股疼痛患者进行阿片类药物使用史评估，这应成为标准做法。
