From the Department of Family Medicine, Oregon Health & Science University, Portland (EO, JL, SRB); Department of Primary Care and Medical Education, University of Tsukuba, Tsukuba, Japan (TM).
J Am Board Fam Med. 2020 Nov-Dec;33(6):858-870. doi: 10.3122/jabfm.2020.06.200096.
The prescription of opioids for acute pain may be a driving factor in chronic opioid abuse. We examined patients' characteristics associated with the expectation of the receipt of opioid prescriptions for acute pain control.
A 1-time survey was administered to adult patients at family medicine clinics in the Pacific Northwest between November 2018 and January 2019. Logistic regression modeled adjusted odds of expecting an opioid prescription in ≥ 3 of the 4 dispositional acute pain scenarios by patient demographics, opioid use, past-week pain intensity and duration, past-week anxiety, and pain catastrophizing.
The survey was completed by 108 patients (62% female, 48% between 30 and 49 years of age, 75% non-Hispanic Whites). Most patients (71%) expected an opioid prescription in ≥ 1 of the 4 scenarios; 26% expected a prescription in ≥ 3 scenarios. Patients with higher levels of pain catastrophizing had more than 3 times greater odds of expecting opioids than those with lower pain catastrophizing (OR, 3.73; = .032; 95% CI, 1.12-12.46); no other characteristics were statistically significant.
Higher pain catastrophizing was associated with increased odds of expecting opioids in dispositional acute pain scenarios in outpatient settings. Future studies can determine whether addressing pain catastrophizing reduces expectations of opioid prescribing for acute pain control. The finding that most patients expected opioid prescriptions in acute pain scenarios needs further exploration into other potential factors associated with these expectations. Evidence-based guidelines for condition-specific acute pain management are warranted for appropriate opioid prescribing and to guide treatment expectations.
开具阿片类药物治疗急性疼痛可能是导致慢性阿片类药物滥用的一个驱动因素。我们研究了与接受阿片类药物处方治疗急性疼痛控制的预期相关的患者特征。
2018 年 11 月至 2019 年 1 月期间，我们在西北太平洋地区的家庭医学诊所对成年患者进行了一次性调查。通过患者人口统计学、阿片类药物使用、过去一周疼痛强度和持续时间、过去一周焦虑以及疼痛灾难化，对 4 种情境性急性疼痛场景中≥3 种情况下预期阿片类药物处方的调整后比值比进行逻辑回归模型分析。
共有 108 名患者（62%为女性，48%年龄在 30 至 49 岁之间，75%为非西班牙裔白人）完成了调查。大多数患者（71%）预计在≥1 种情况下会开阿片类药物处方；26%的患者预计在≥3 种情况下会开处方。疼痛灾难化程度较高的患者比疼痛灾难化程度较低的患者预期阿片类药物的可能性高出 3 倍以上（OR，3.73；P=.032；95%CI，1.12-12.46）；其他特征均无统计学意义。
较高的疼痛灾难化与门诊环境中情境性急性疼痛场景中增加预期阿片类药物的可能性相关。未来的研究可以确定是否解决疼痛灾难化可以降低对急性疼痛控制的阿片类药物处方的期望。大多数患者在急性疼痛场景中预期阿片类药物处方的发现需要进一步探讨与这些预期相关的其他潜在因素。需要制定针对特定疾病的急性疼痛管理循证指南，以规范阿片类药物的使用，并指导治疗预期。
