Shergill Yaadwinder, Poulin Patricia, Rice Danielle, Rash Joshua A, Hebert Guy, Tennant Emily, Khoo Eve-Ling, Romanow Heather, Singer Lesley, Jarvis Virginia, Nathan Howard, Smyth Catherine
The Ottawa Hospital Research Institute Ottawa Ontario Canada.
Department of Health Research Methods Evidence and Impact McMaster University Hamilton Ontario Canada.
J Am Coll Emerg Physicians Open. 2022 Jan 22;3(1):e12628. doi: 10.1002/emp2.12628. eCollection 2022 Feb.
To evaluate the effect of a collaborative interdisciplinary pain assessment program on pain and health-related quality of life among individuals with chronic pain who frequently visit the emergency department (ED).
Individuals with chronic pain who frequented the ED (ie, ≥8 visits within the previous 12 months) were randomly assigned to a collaborative chronic pain management program or treatment as usual. Primary outcomes were change in physical function and visits to the ED from baseline to 12 months using validated measures. Secondary measures included physical and emotional functioning, insomnia, health-related quality of life, risk of aberrant opioid use, and health care use. Mixed model analyses of variances were used to evaluate intervention effectiveness among the whole sample (ie, using intention to treat principles) and individuals who completed more than 50% of follow-up assessments.
One hundred participants were assessed for eligibility and 46 patients were enrolled with 24 being randomized to intervention and 22 to treatment as usual (TAU). Eleven of the 24 patients randomized to the intervention were lost to follow-up and 3 withdrew participation. Two of the 22 patients randomized to TAU were lost to follow-up, and 7 withdrew. Although patients assigned to the intervention improved more rapidly on measures of pain and health related quality of life, both groups had similar improvements overall between baseline to 12 months. Average pain intensity reduction (numeric rating scale [SE]) was 4.63 (0.40) in the intervention and 4.82 (0.53) in the treatment as usual at the 12-month follow-up. A significant group × time interaction was present for risk of aberrant opioid use, with individuals in the intervention group reporting greater improvement in risk of aberrant opioid use by 12-month follow-up.
Participation in an interdisciplinary program may accelerate improvements in pain- and health-related quality of life and reduce risk of aberrant opioid use to manage pain and related distress. Further research is needed to better understand and address barriers to engagement in chronic pain care.
评估一项跨学科协作疼痛评估项目对经常前往急诊科（ED）的慢性疼痛患者的疼痛及健康相关生活质量的影响。
将经常前往急诊科（即过去12个月内就诊≥8次）的慢性疼痛患者随机分为协作性慢性疼痛管理项目组或常规治疗组。主要结局指标为使用经过验证的测量方法，从基线到12个月时身体功能的变化以及急诊科就诊次数。次要测量指标包括身体和情绪功能、失眠、健康相关生活质量、异常使用阿片类药物的风险以及医疗保健利用情况。采用方差混合模型分析来评估整个样本（即采用意向性分析原则）以及完成超过50%随访评估的个体的干预效果。
对100名参与者进行了资格评估，46名患者入组，其中24名被随机分配至干预组，22名被分配至常规治疗组（TAU）。随机分配至干预组的24名患者中有11名失访，3名退出研究。随机分配至TAU组的22名患者中有2名失访，7名退出。尽管分配至干预组的患者在疼痛和健康相关生活质量测量指标上改善得更快，但两组在基线至12个月期间总体改善情况相似。在12个月随访时，干预组平均疼痛强度降低（数字评分量表[标准误]）为4.63（0.40），常规治疗组为4.82（0.53）。在异常使用阿片类药物风险方面存在显著的组×时间交互作用，干预组个体在12个月随访时报告异常使用阿片类药物风险有更大改善。
参与跨学科项目可能会加速疼痛和健康相关生活质量的改善，并降低为控制疼痛及相关痛苦而异常使用阿片类药物的风险。需要进一步研究以更好地理解和解决慢性疼痛护理参与方面的障碍。
