Hsu Yung-Chi, Lin Shinn-Long, Sung Chun-Sung, Ger Luo-Ping, Liou Huei-Han, Lin Tso-Chou, Ho Shung-Tai
Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Integrated Pain Management Center, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, ROC.
J Chin Med Assoc. 2021 Feb 1;84(2):227-232. doi: 10.1097/JCMA.0000000000000468.
Prescribing opioids for patients with chronic noncancer pain (CNCP) remains controversial. This study surveyed Taiwanese physicians who were clinically treating CNCP outpatients with long-term opioids.
Anonymous questionnaires investigating the clinical practices, opioid knowledge, attitude, and barriers regarding the prescription of long-term opioids were delivered to 66 physicians treating CNCP outpatients who were officially registered and monitored by the Taiwan Food and Drug Administration in 2011.
All 66 (100%) physicians responded to the survey, comprising 41 (62%) board-certified pain specialists and 25 (38%) nonpain board-certified physicians. Pain specialists treated a greater number of CNCP outpatients and attended more CNCP training courses than nonpain board-certified physicians (97.6% vs. 56.0%, p < 0.001). Most of pain specialists stated that they were familiar with the Taiwan's narcotic regulations for CNCP patients (92.7% vs. 68.0%, p = 0.015). In addition, pain specialists were less likely to skip or reduce the dosage and duration of opioid prescriptions (22.0% vs. 36.0%, p < 0.001). By contrast, nonpain board-certified physicians had significantly less knowledge and a more negative attitude toward opioid prescription. The major perceived barriers were physician's reluctance to prescribe opioids (78% vs. 92%) and an inadequate knowledge of pain management (73% vs. 84%) among all physicians.
Among the Taiwanese physicians treating the officially registered CNCP patients, nonpain board-certified physicians had fewer patients, less knowledge, and an increased negative attitude toward long-term opioid prescriptions. Better education on chronic pain management is needed for improvement of clinical practice.
为慢性非癌性疼痛（CNCP）患者开具阿片类药物仍然存在争议。本研究调查了临床上长期使用阿片类药物治疗CNCP门诊患者的台湾医生。
向66名在2011年由台湾食品药品管理局正式注册并监测的治疗CNCP门诊患者的医生发放了匿名问卷，调查他们关于长期阿片类药物处方的临床实践、阿片类药物知识、态度和障碍。
所有66名（100%）医生回复了调查，其中包括41名（62%）获得委员会认证的疼痛专科医生和25名（38%）未获得疼痛专科委员会认证的医生。与未获得疼痛专科委员会认证的医生相比，疼痛专科医生治疗的CNCP门诊患者更多，参加的CNCP培训课程也更多（97.6%对56.0%，p<0.001）。大多数疼痛专科医生表示他们熟悉台湾针对CNCP患者的麻醉药品管理规定（92.7%对68.0%，p = 0.015）。此外，疼痛专科医生较少跳过或减少阿片类药物处方的剂量和疗程（22.0%对36.0%，p<0.001）。相比之下，未获得疼痛专科委员会认证的医生对阿片类药物处方的知识明显较少，态度也更消极。所有医生认为的主要障碍是医生不愿开具阿片类药物（78%对92%）以及疼痛管理知识不足（73%对84%）。
在治疗经正式注册的CNCP患者的台湾医生中，未获得疼痛专科委员会认证的医生患者较少，知识较少，对长期阿片类药物处方的消极态度增加。需要更好地开展慢性疼痛管理教育以改善临床实践。
