Svanberg Mikael, Stålnacke Britt-Marie, Quinn Patrick D, Boersma Katja
School of Health Sciences, Faculty of Medicine and Health, Örebro University, SE-701 85 Örebro, Sweden.
Centre for Clinical Research, Uppsala University, County Hospital, SE-721 89 Västerås, Sweden.
J Clin Med. 2021 May 14;10(10):2130. doi: 10.3390/jcm10102130.
While against recommendations, long-term opioid therapy (LTOT) for chronic pain is common. This study aimed to describe the prevalence of opioid prescriptions and to study the association of patient characteristics (demographics, pain characteristics, anxiety, depressive symptoms and pain coping) with future LTOT. The sample included = 1334 chronic musculoskeletal pain patients, aged 18-65, who were assessed for Interdisciplinary Multimodal Pain Rehabilitation (IMMR) in Swedish specialist rehabilitation. Prescriptions were tracked across a two-year target period after assessment. In total, 9100 opioid prescriptions were prescribed to 55% of the sample (M = 6, IQR = 14). Prediction of LTOT was analyzed separately for those who did (24%) and did not (76%) receive IMMR. The odds of receiving opioids was similar for these subsamples, after controlling for differences in baseline characteristics. In both samples, there were significant associations between patient characteristics and future opioid prescriptions. Dysfunctional pain coping was a unique predictor of LTOT in those who received IMMR while pain intensity and depressive symptoms were unique predictors in those who did not receive IMMR. The results underscore that opioid treatment is common among patients in chronic pain rehabilitation and relates to pain and psychological factors. Understanding in detail why these factors relate to opioid prescription patterns is an important future study area as it is a prerequisite for better management and fundamental for preventing overuse.
尽管有悖于建议，但长期阿片类药物治疗（LTOT）用于慢性疼痛的情况却很常见。本研究旨在描述阿片类药物处方的流行情况，并研究患者特征（人口统计学、疼痛特征、焦虑、抑郁症状和疼痛应对方式）与未来LTOT之间的关联。样本包括1334名年龄在18 - 65岁之间的慢性肌肉骨骼疼痛患者，他们在瑞典专科康复机构接受了跨学科多模式疼痛康复（IMMR）评估。在评估后的两年目标期内对处方进行跟踪。总共为55%的样本（中位数 = 6，四分位距 = 14）开出了9100份阿片类药物处方。分别对接受（24%）和未接受（76%）IMMR的患者分析LTOT的预测情况。在控制了基线特征差异后，这些亚样本接受阿片类药物的几率相似。在两个样本中，患者特征与未来阿片类药物处方之间均存在显著关联。功能失调的疼痛应对方式是接受IMMR患者LTOT的独特预测因素，而疼痛强度和抑郁症状是未接受IMMR患者LTOT的独特预测因素。结果强调，阿片类药物治疗在慢性疼痛康复患者中很常见，且与疼痛和心理因素有关。详细了解这些因素为何与阿片类药物处方模式相关是未来一个重要的研究领域，因为这是更好管理的前提条件，也是预防药物过度使用的基础。
