Saïdi Hichem, Pagé M Gabrielle, Boulanger Aline, Ware Mark A, Choinière Manon
Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
Department of Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Can J Pain. 2018 Apr 19;2(1):113-124. doi: 10.1080/24740527.2018.1451252. eCollection 2018.
The objective of this study was to investigate in a real-life context the effectiveness of long-term opioid therapy for reducing pain intensity and interference and improving health-related quality of life (QOL) in patients with chronic noncancer pain.
Participants were 893 patients (age = 52.4 ± 14.1, female = 62.4%) enrolled in the Quebec Pain Registry (2008-2011) who completed questionnaires before their first visit at one of three multidisciplinary pain management clinics and 6 and 12 months thereafter. Based on their opioid use profile (OUP), patients were categorized as nonusers, non-lasting users, or lasting users. Data were analyzed using generalized estimating equations.
More than 60% of patients newly initiated on opioid therapy stopped their medication mainly because of adverse effects and/or lack of pain relief. OUP significantly predicted pain intensity and interference and physical QOL (pQOL; values < 0.001). Lasting users of opioids reported higher levels of pain intensity and interference and poorer pQOL than nonusers and/or non-lasting users over the 12-month follow-up ( values < 0.001). However, all effect sizes were small, thus questioning the clinical significance of these group differences. Among lasting users, more than 20% of patients experienced a meaningful amelioration in pain intensity and interference as well as mental QOL (mQOL), whereas only 8% exhibited improved pQOL.
A significant subgroup of patients may benefit from long-term opioid therapy in terms of pain severity and mQOL but the majority do not. The challenge facing clinicians is how to identify who the responders will be.
本研究的目的是在现实生活背景下，调查长期阿片类药物治疗对减轻慢性非癌性疼痛患者的疼痛强度和干扰以及改善健康相关生活质量（QOL）的有效性。
参与者为893名患者（年龄 = 52.4 ± 14.1，女性 = 62.4%），他们被纳入魁北克疼痛登记处（2008 - 2011年），在首次就诊于三家多学科疼痛管理诊所之一之前以及之后6个月和12个月完成问卷调查。根据他们的阿片类药物使用情况（OUP），患者被分为非使用者、非持续使用者或持续使用者。使用广义估计方程对数据进行分析。
超过60%新开始使用阿片类药物治疗的患者停止用药，主要原因是不良反应和/或疼痛未缓解。OUP显著预测了疼痛强度、干扰和身体生活质量（pQOL；值 < 0.001）。在12个月的随访中，阿片类药物的持续使用者报告的疼痛强度和干扰水平高于非使用者和/或非持续使用者，pQOL较差（值 < 0.001）。然而，所有效应量都很小，因此质疑这些组间差异的临床意义。在持续使用者中，超过20%的患者在疼痛强度、干扰以及心理生活质量（mQOL）方面有显著改善，而只有8%的患者pQOL有所改善。
相当一部分患者可能从长期阿片类药物治疗中在疼痛严重程度和mQOL方面获益，但大多数患者并非如此。临床医生面临的挑战是如何识别哪些患者会有反应。
