Hayes Corey J, Gressler Laura E, Hu Bo, Jones Bobby L, Williams J Silas, Martin Bradley C
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.
Center of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
J Pain Res. 2021 Jun 14;14:1745-1762. doi: 10.2147/JPR.S308196. eCollection 2021.
The objective of this study was to identify the trajectories that patients take after initiating long-term opioid therapy (LTOT).
Using a retrospective cohort design, veterans with chronic non-cancer pain (CNCP) initiating LTOT were identified. Group-based trajectory models were used to identify opioid therapy trajectories based on days of opioid supply (primary outcome) and average daily morphine milligram equivalent dose (AMME; secondary outcome) in each 180-day period following initiation of LTOT.
A total of 438,398 veterans with CNCP initiated LTOT. Nine trajectories were identified: 33.7% with persistent, high days covered, 17.7% with persistent, moderate days covered, 16.6% with slow, persistent days-covered reduction, 2.4% with days-covered reduction followed by increase, 4.6% with delayed days-covered reduction, 4.1% with rapid days-covered reduction, 10.9% with moderate-paced discontinuation, 3.4% with delayed discontinuation, and 6.5% with rapid discontinuation. Patients following discontinuation trajectories were more likely to be younger, persons of color, use more supportive services (eg, physical therapy), and received less opioid days' supply and lower doses prior to initiating LTOT as compared to patients following persistent opioid days-covered trajectories. AMME trajectories were similar to days-covered trajectories.
Among persons initiating LTOT, nine opioid trajectories emerged which can be broadly characterized into three main trajectory groups: persistent opioid therapy (2 trajectories), reductions in opioid therapy (4 trajectories), and discontinuation (3 trajectories). A majority of patients (51.4%) maintained persistent opioid therapy. Further research is needed to assess the risks of opioid-related adverse outcomes among the identified trajectories.
本研究的目的是确定患者开始长期阿片类药物治疗（LTOT）后的轨迹。
采用回顾性队列设计，确定开始LTOT的慢性非癌性疼痛（CNCP）退伍军人。基于组的轨迹模型用于根据LTOT开始后每180天的阿片类药物供应天数（主要结局）和平均每日吗啡毫克当量剂量（AMME；次要结局）确定阿片类药物治疗轨迹。
共有438,398名CNCP退伍军人开始LTOT。确定了九条轨迹：33.7%为持续、高覆盖天数，17.7%为持续、中等覆盖天数，16.6%为缓慢、持续的覆盖天数减少，2.4%为覆盖天数先减少后增加，4.6%为延迟的覆盖天数减少，4.1%为快速的覆盖天数减少，10.9%为中等速度停药，3.4%为延迟停药，6.5%为快速停药。与遵循持续阿片类药物覆盖天数轨迹的患者相比，遵循停药轨迹的患者更可能年轻、为有色人种、使用更多支持性服务（如物理治疗），并且在开始LTOT之前接受的阿片类药物供应天数和剂量更低。AMME轨迹与覆盖天数轨迹相似。
在开始LTOT的人群中，出现了九条阿片类药物轨迹，可大致分为三个主要轨迹组：持续阿片类药物治疗（2条轨迹）、阿片类药物治疗减少（4条轨迹）和停药（3条轨迹）。大多数患者（51.4%）维持持续阿片类药物治疗。需要进一步研究以评估已确定轨迹中与阿片类药物相关不良结局的风险。
