Shah Romil Fenil, Gwilym Stephen E, Lamb Sarah, Williams Mark, Ring David, Jayakumar Prakash
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Texas, USA.
Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, UK.
Bone Jt Open. 2021 Feb;2(2):119-124. doi: 10.1302/2633-1462.22.BJO-2020-0167.R1.
The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an upper limb fracture.
A total of 734 patients recovering from an isolated upper limb fracture were recruited in this study. Opioid prescription was documented retrospectively for the period preceding the injury, and prospectively at the two- to four-week post-injury visit and six- to nine-month post-injury visit. Bivariate and multivariate analysis sought factors associated with opioid prescription from demographics, injury-specific data, Patient Reported Outcome Measurement Instrumentation System (PROMIS), Depression computer adaptive test (CAT), PROMIS Anxiety CAT, PROMIS Instrumental Support CAT, the Pain Catastrophizing Scale (PCS), the Pain Self-efficacy Questionnaire (PSEQ-2), Tampa Scale for Kinesiophobia (TSK-11), and measures that investigate levels of social support.
A new prescription of opioids two to four weeks after injury was independently associated with less social support (odds ratio (OR) 0.26, p < 0.001), less instrumental support (OR 0.91, p < 0.001), and greater symptoms of anxiety (OR 1.1, p < 0.001). A new prescription of opioids six to nine months after injury was independently associated with less instrumental support (OR 0.9, p < 0.001) and greater symptoms of anxiety (OR 1.1, p < 0.001).
This study demonstrates that potentially modifiable psychosocial factors are associated with increased acute and chronic opioid prescriptions following upper limb fracture. Surgeons prescribing opioids for upper limb fractures should be made aware of the screening and management of emotional and social health. Cite this article: 2021;2(2):119-124.
处方类阿片药物滥用和依赖现象的增加如今已成为英国的一个公共卫生危机。它被视为一个涉及患者医疗和心理社会需求的整体人的问题。分析与受伤后持续使用阿片类药物相关的病理生理学、情绪健康和社会福祉等方面，可能有助于在将滥用或依赖风险降至最低的同时，安全有效地缓解疼痛。我们的目标是调查上肢骨折后两至四周以及六至九个月与阿片类药物使用相关的患者因素。
本研究共招募了734名从单纯上肢骨折中恢复的患者。回顾性记录受伤前一段时间的阿片类药物处方，并前瞻性记录受伤后两至四周以及六至九个月复诊时的处方。双变量和多变量分析从人口统计学、损伤特异性数据、患者报告结局测量工具系统（PROMIS）、抑郁计算机自适应测试（CAT）、PROMIS焦虑CAT、PROMIS工具性支持CAT、疼痛灾难化量表（PCS）、疼痛自我效能问卷（PSEQ - 2）、坦帕运动恐惧量表（TSK - 11）以及调查社会支持水平的指标中寻找与阿片类药物处方相关的因素。
受伤后两至四周新开阿片类药物处方与社会支持较少（比值比（OR）0.26，p < 0.001）、工具性支持较少（OR 0.91，p < 0.001）以及焦虑症状较重（OR 1.1，p < 0.001）独立相关。受伤后六至九个月新开阿片类药物处方与工具性支持较少（OR 0.9，p < 0.001）以及焦虑症状较重（OR 1.1，p < 0.001）独立相关。
本研究表明，潜在可改变的心理社会因素与上肢骨折后急性和慢性阿片类药物处方增加有关。为上肢骨折患者开阿片类药物的外科医生应了解情绪和社会健康的筛查与管理。引用本文：2021；2(2):119 - 124。
