Division of General Internal Medicine, Department of Medicine, Harborview Medical Center and University of Washington School of Medicine, Seattle, WA, USA.
Division of General Internal Medicine, Center for Research on Health Care, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
AIDS Care. 2023 Aug;35(8):1173-1180. doi: 10.1080/09540121.2021.1876838. Epub 2021 Feb 4.
Persons with HIV (PWH) experience chronic pain and Post-Traumatic Stress Disorder (PTSD) at higher rates than the general population, and more often receive opioid medications to treat chronic pain. A known association exists between PTSD and substance use disorders, but less is known about the relationship between PTSD and risky opioid use among PWH taking prescribed opioid medications. In this observational study of PWH on long-term opioid medications for pain we examined associations between PTSD symptom severity based on the Post Traumatic Stress Disorder Checklist for DSM-5 (PCL-5, response range 0-80) and the following outcomes: 1) risk for opioid misuse (COMM score ≥13); 2) risky alcohol use (AUDIT score ≥8); 3) concurrent benzodiazepine prescription; and 4) morphine equivalent dose. Among 166 patients, 38 (23%) had a PCL-5 score over 38, indicating high PTSD symptom burden. Higher PCL-5 score (per 10 point difference) was associated with increased odds of opioid misuse (aOR 1.55; 95%CI: 1.31-1.83) and risky drinking (aOR: 1.28;1.07-1.52). No significant association was observed between PCL-5 score and benzodiazepine prescriptions or morphine equivalent dose. These findings suggest that when addressing alcohol and opioid use in PWH on long term opioid therapy, attention to PTSD symptoms is especially important given the higher risk for risky alcohol and opioid use among patients with this common comorbid condition.
艾滋病毒感染者（PWH）经历慢性疼痛和创伤后应激障碍（PTSD）的比率高于一般人群，并且更经常接受阿片类药物治疗慢性疼痛。已知 PTSD 与物质使用障碍之间存在关联，但对于接受处方阿片类药物治疗慢性疼痛的 PWH 中 PTSD 与危险阿片类药物使用之间的关系知之甚少。在这项针对长期接受阿片类药物治疗疼痛的 PWH 的观察性研究中，我们根据《精神疾病诊断与统计手册第五版创伤后应激障碍检查表》（PCL-5，反应范围 0-80）评估了 PTSD 症状严重程度与以下结果之间的关联：1）阿片类药物滥用风险（COMM 评分≥13）；2）危险饮酒（AUDIT 评分≥8）；3）同时开具苯二氮䓬类药物处方；和 4）吗啡等效剂量。在 166 名患者中，有 38 名（23%）的 PCL-5 评分超过 38，表明 PTSD 症状负担高。PCL-5 评分每增加 10 分（每增加 10 分），阿片类药物滥用的几率增加（优势比 1.55；95%CI：1.31-1.83）和危险饮酒（优势比：1.28；1.07-1.52）。PCL-5 评分与苯二氮䓬类药物处方或吗啡等效剂量之间无显著相关性。这些发现表明，在长期接受阿片类药物治疗的 PWH 中解决酒精和阿片类药物使用问题时，鉴于患有这种常见合并症的患者发生危险酒精和阿片类药物使用的风险更高，因此特别需要注意 PTSD 症状。
