Founder and former Medical Director of The Focus on Opioid Transitions Program, Integrated Pain Management Medical Group Inc, Walnut Creek, California, USA.
College of Nursing, University of Arizona, Tucson, Arizona, USA.
Pain Med. 2021 Sep 8;22(9):2106-2116. doi: 10.1093/pm/pnab069.
To describe differences between patients with chronic, non-cancer pain (CNCP) who were successfully able to cease full mu agonist chronic opioid analgesic therapy (COAT), and those who exhibited refractory COAT reliance, among those who participated in a multidisciplinary program designed for COAT cessation.
A retrospective review of electronic medical records (EMR) data was organized for preliminary analysis.
A multicenter private practice specializing in CNCP, which received patient referrals from the surrounding geographical area of primary and specialty care offices in Northern California.
Data from 109 patients with CNCP who participated in a multidisciplinary program to cease COAT between the dates of October 2017 to December 2019 were examined.
EMR data, pre-COAT cessation, of oral morphine milligram equivalence (MME) and validated questionnaire responses assessing anxiety and fear-based beliefs and behavior, as well as opioid misuse, were extracted and compared between those who successfully ceased COAT and those who did not.
Patients who were unsuccessful at COAT cessation reported significantly higher Fear Avoidance Beliefs Questionnaire (FAB) scores. No significant differences were found based on incoming MME amounts, Current Opioid Misuse Measure (COMM) or Tampa Scale of Kinesiophobia (TSK) scores. Pain Catastrophizing Scale (PCS) scores showed a split pattern with unclear significance.
Results suggest that fear avoidance beliefs and behavior, as measured by the FAB, play a significant role in refractory COAT reliance for patients with CNCP.
描述参与旨在停止慢性阿片类药物治疗的多学科项目的慢性非癌性疼痛（CNCP）患者中，成功停止全 μ 阿片激动剂慢性阿片类药物镇痛治疗（COAT）的患者与表现出难治性 COAT 依赖的患者之间的差异。
对电子病历（EMR）数据进行回顾性分析，进行初步分析。
一家专门治疗 CNCP 的多学科私人诊所，从加利福尼亚北部的初级和专科护理办公室的周边地区接收患者转诊。
检查了 2017 年 10 月至 2019 年 12 月期间参加停止 COAT 的多学科项目的 109 名 CNCP 患者的 EMR 数据。
提取并比较了停止 COAT 成功和不成功的患者的 COAT 停止前的口服吗啡毫克当量（MME）和评估焦虑和基于恐惧的信念和行为以及阿片类药物滥用的验证问卷的回答。
未能成功停止 COAT 的患者报告的恐惧回避信念问卷（FAB）得分明显更高。根据传入的 MME 量、当前阿片类药物滥用量表（COMM）或坦帕量表的运动恐惧症（TSK）得分，没有发现显著差异。疼痛灾难化量表（PCS）得分表现出分裂模式，意义不明确。
结果表明，恐惧回避信念和行为（由 FAB 测量）在 CNCP 患者难治性 COAT 依赖中起重要作用。
