Department of Occupational and Environmental Medicine, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Kløvervænget 3, 5000, Odense, Denmark.
Department of Clinical Research, OPEN - Open Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Eur Spine J. 2021 Oct;30(10):2989-2998. doi: 10.1007/s00586-021-06849-6. Epub 2021 Apr 24.
No reference material exists on the scope of long-term problems in novel spinal pain opioid users. In this study, we evaluate the prevalence and long-term use of prescribed opioids in patients of the Spinal Pain Opioid Cohort.
The setting was an outpatient healthcare entity (Spine Center). Prospective variables include demographics, clinical data collected in SpineData, and The Danish National Prescription Registry. Patients with a new spinal pain episode lasting for more than two months, aged between 18 and 65 years, who had their first outpatient visit. Based on the prescription of opioids from 4 years before the first spine center visit to 5 years after, six or more opioid prescriptions in a single 1-year interval fulfilled the main outcome criteria Long-Term Opioid Therapy (LTOT).
Overall, of 8356 patients included in the cohort, 4409 (53%) had one or more opioid prescriptions in the registered nine years period. Of opioid users, 2261 (27%) were NaiveStarters receiving their first opioid prescription after a new acute pain episode; 2148(26%) PreStarters had previously received opioids. The prevalence of LTOT in PreStarters/NaiveStarters was 17.2%/11.2% in their first outpatient year. Similar differences between groups were seen in all follow-up intervals. In the last follow-up year, LTOT prevalence in Prestarters/NaiveStarters was 12.5%/7.0%.
Previous opioid treatment-i.e., before a new acute spinal pain episode and referral to a Spine Center-doubled the risk of LTOT 5 years later. The results underscore clinicians' obligation to carefully and individually weigh the benefits against the risks of prescribing opioid therapy.
Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
目前尚无关于新型脊柱疼痛阿片类药物使用者长期问题范围的参考资料。在这项研究中，我们评估了 SpinalPainOpioidCohort 中患者规定阿片类药物的使用频率和长期使用情况。
该研究场所为一家门诊医疗保健机构（脊柱中心）。前瞻性变量包括人口统计学数据、在 SpineData 中收集的临床数据以及丹麦国家处方登记处。新的脊柱疼痛发作持续时间超过两个月、年龄在 18 至 65 岁之间、首次门诊就诊的患者符合纳入标准。根据首次脊柱中心就诊前 4 年至就诊后 5 年内的阿片类药物处方，在单一 1 年间隔内开出 6 次或以上阿片类药物处方符合长期阿片类药物治疗（LTOT）的主要结局标准。
在纳入的 8356 名患者中，总体上有 4409 名（53%）在注册的 9 年期间内有一个或多个阿片类药物处方。在阿片类药物使用者中，2261 名（27%）为初次使用者，在新发急性疼痛发作后首次开具阿片类药物处方；2148 名（26%）为预先使用者此前曾接受过阿片类药物治疗。预先使用者/初次使用者在第一个门诊年度的 LTOT 患病率分别为 17.2%/11.2%。在所有随访间隔内，两组之间均存在类似差异。在最后一次随访年度，预先使用者/初次使用者的 LTOT 患病率分别为 12.5%/7.0%。
在新的急性脊柱疼痛发作之前以及转至脊柱中心之前，先前的阿片类药物治疗增加了 5 年后 LTOT 的风险，风险增加了一倍。结果强调了临床医生有义务仔细并个体化权衡开具阿片类药物治疗的获益与风险。
证据水平 I：诊断：具有一致应用参考标准和盲法的个体横断面研究。
