Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO, USA.
Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
J Gen Intern Med. 2020 Dec;35(Suppl 3):910-917. doi: 10.1007/s11606-020-06294-z. Epub 2020 Nov 3.
There is inadequate evidence of long-term benefit from opioid medications for chronic pain and substantial evidence of potential harms. For patients, dose reduction may be beneficial when implemented voluntarily and supported by a multidisciplinary team but experts have advised against involuntary opioid reduction.
To assess the prevalence of self-reported involuntary opioid reduction and to examine whether involuntary opioid reduction is associated with changes in pain severity.
Prospective observational cohort study.
Primary care patients treated with long-term opioid therapy in the Veterans Health Administration (N = 290).
The primary exposure was self-reported past year involuntary opioid reduction. The primary outcome was the three-item PEG scale, which measures past-week average pain intensity and interference with enjoyment of life and general activity.
Past year opioid reduction or discontinuation was reported by 63% (184/290). Similar numbers reported involuntary (88/290) and voluntary (96/290) opioid reduction. At baseline, there were no significant differences in pain severity between the groups (mean PEG, 7.08 vs. 6.73 vs. 7.07 for past year involuntary opioid reduction, past year voluntary opioid reduction, and no past year opioid reduction, respectively; P = 0.32). For the primary outcome of change in pain severity from baseline to 18 months, there were no significant differences between groups (mean PEG change, - 0.05 vs. - 0.44 vs. - 0.23 for past year involuntary opioid reduction, past year voluntary opioid reduction, and no past year opioid reduction, respectively; P = 0.28).
Self-reported past year involuntary opioid reduction was common among a national sample of veterans treated with long-term opioid therapy. Opioid dose reduction, whether involuntary or voluntary, was not associated with change in pain severity. Future studies should examine involuntary opioid reduction in different populations and trends over time and explore further patient- and provider-level factors that may impact patient experience and outcomes during opioid reduction.
阿片类药物治疗慢性疼痛的长期获益证据不足，而潜在危害的证据却相当充分。对于患者而言，如果能在多学科团队的支持下自愿减少剂量，可能会有益处，但专家们反对非自愿减少阿片类药物的用量。
评估报告中自我报告的非自愿阿片类药物减少的流行程度，并考察非自愿阿片类药物减少是否与疼痛严重程度的变化有关。
前瞻性观察队列研究。
在退伍军人事务部（Veterans Health Administration，VHA）接受长期阿片类药物治疗的初级保健患者（N=290）。
主要暴露因素为过去一年中自我报告的非自愿阿片类药物减少。主要结局指标是 PEG 量表的三个项目，该量表衡量过去一周的平均疼痛强度以及对生活乐趣和一般活动的干扰程度。
290 名患者中，有 63%（184/290）报告过去一年中阿片类药物减少或停药。同样数量的患者报告非自愿（88/290）和自愿（96/290）减少阿片类药物用量。在基线时，各组的疼痛严重程度没有显著差异（过去一年非自愿阿片类药物减少、过去一年自愿阿片类药物减少和过去一年无阿片类药物减少的患者的平均 PEG 评分分别为 7.08、6.73 和 7.07；P=0.32）。在疼痛严重程度从基线到 18 个月的变化的主要结局方面，各组之间没有显著差异（过去一年非自愿阿片类药物减少、过去一年自愿阿片类药物减少和过去一年无阿片类药物减少的患者的平均 PEG 评分变化分别为-0.05、-0.44 和-0.23；P=0.28）。
在接受长期阿片类药物治疗的退伍军人的全国性样本中，自我报告的过去一年非自愿阿片类药物减少很常见。阿片类药物剂量减少，无论是非自愿还是自愿，与疼痛严重程度的变化均无关。未来的研究应该在不同人群中考察非自愿阿片类药物减少的情况，并探讨随着时间的推移的趋势，以及进一步研究可能影响阿片类药物减少期间患者体验和结局的患者和提供者层面的因素。
