University of Washington School of Medicine, Seattle, WA, USA.
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
BMC Public Health. 2021 Mar 22;21(1):564. doi: 10.1186/s12889-021-10566-6.
BACKGROUND: Alcohol use is common among persons living with HIV (PLWH), who often experience chronic pain, yet its impact on pain and opioid misuse is not fully characterized. METHODS: We assessed associations between hazardous alcohol use and pain interference, defined as the self-reported impact of pain on daily living, pain severity, and risk for opioid misuse among PLWH who were on long-term opioid therapy (LTOT). A cohort was recruited as part of the "Targeting Effective Analgesia in Clinics for HIV" (TEACH) study, a randomized controlled trial to improve LTOT in HIV clinics. The Alcohol Use Disorders Test (AUDIT), Brief Pain Inventory (BPI) and the Current Opioid Misuse Measure (COMM) were administered at both baseline and 12-months. Linear mixed and generalized estimating equation models, incorporating data from both time points, evaluated associations between hazardous alcohol use (AUDIT ≥8) and: pain interference (0-10), pain severity (0-10), and opioid misuse risk (COMM ≥13), adjusting for age, gender, depressive symptoms, use of non-alcohol substances, time-point, and study-arm. RESULTS: The sample was comprised of 166 participants, of which 31 (19%) reported hazardous alcohol use. The majority were male (65%), black (72%), and the mean age was 54 (range: 29-77). Hazardous alcohol use was significantly associated with higher pain interference (adjusted mean difference [AMD]: 1.02; 95% CI: 0.08, 1.96) and higher odds of opioid misuse risk (AOR: 3.73, 95% CI: 1.88-7.39), but not pain severity (AMD: 0.47, 95% CI: - 0.35, 1.29). CONCLUSIONS: Hazardous alcohol use was associated with greater functional impairment in daily living from their pain and higher odds for prescription opioid misuse in this study of PLWH on LTOT. Providers should be attentive to alcohol use among PLWH who are prescribed opioids given associations with pain and opioid misuse. TRIAL REGISTRATION: ClinicalTrials.gov NCT02564341 (Intervention, September 30, 2015) and NCT02525731 (Patient Cohort, August 17, 2015). Both prospectively registered.
背景：在 HIV 感染者（PLWH）中，饮酒较为常见，他们常伴有慢性疼痛，但目前尚未充分明确饮酒对疼痛和阿片类药物滥用的影响。
方法：我们评估了长期接受阿片类药物治疗（LTOT）的 PLWH 中，危险饮酒与疼痛干扰、疼痛严重程度和阿片类药物滥用风险之间的相关性。这项研究作为“在 HIV 诊所中靶向有效镇痛”（TEACH）研究的一部分进行，该研究是一项随机对照试验，旨在改善 HIV 诊所中的 LTOT。在基线和 12 个月时，同时使用酒精使用障碍测试（AUDIT）、简明疼痛量表（BPI）和当前阿片类药物滥用测量（COMM）进行评估。采用线性混合和广义估计方程模型，结合两个时间点的数据，调整年龄、性别、抑郁症状、非酒精物质使用、时间点和研究臂后，评估危险饮酒（AUDIT≥8）与：疼痛干扰（0-10）、疼痛严重程度（0-10）和阿片类药物滥用风险（COMM≥13）之间的相关性。
结果：该样本包括 166 名参与者，其中 31 名（19%）报告有危险饮酒。大多数参与者为男性（65%）、黑人（72%），平均年龄为 54 岁（范围：29-77 岁）。危险饮酒与更高的疼痛干扰（调整平均差值[AMD]：1.02；95%CI：0.08，1.96）和更高的阿片类药物滥用风险（OR：3.73，95%CI：1.88-7.39）显著相关，但与疼痛严重程度（AMD：0.47，95%CI：-0.35，1.29）无关。
结论：在这项接受 LTOT 的 PLWH 研究中，危险饮酒与日常生活中疼痛导致的功能障碍加重和处方类阿片药物滥用风险增加相关。鉴于危险饮酒与疼痛和阿片类药物滥用有关，开具阿片类药物的医生应注意观察 PLWH 的饮酒情况。
试验注册：ClinicalTrials.gov NCT02564341（干预，2015 年 9 月 30 日）和 NCT02525731（患者队列，2015 年 8 月 17 日）。均为前瞻性注册。
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