Gorfinkel Lauren R, Hasin Deborah, Saxon Andrew J, Wall Melanie, Martins Silvia S, Cerdá Magdalena, Keyes Katherine, Fink David S, Keyhani Salomeh, Maynard Charles C, Olfson Mark
The New York State Psychiatric Institute, New York, New York; Department of Medicine, University of British Columbia, Vancouver, Canada.
The New York State Psychiatric Institute, New York, New York; Department of Epidemiology, Columbia University, New York, New York; Department of Psychiatry, Columbia University, New York, New York.
J Pain. 2022 Jul;23(7):1187-1195. doi: 10.1016/j.jpain.2022.01.006. Epub 2022 Feb 8.
As opioid prescribing has declined, it is unclear how the landscape of prescription pain treatment across the U.S. has changed. We used nationally-representative data from the Medical Expenditure Health Survey, 2014 to 2018 to examine trends in prescriptions for opioid and non-opioid pain medications, including acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, and antidepressants among U.S. adults with self-reported pain. Overall, from 2014 to 2018, the percentage of participants receiving a prescription for opioids declined, (38.8% vs 32.8%), remained stable for non-steroidal anti-inflammatory drugs (26.8% vs 27.7%), and increased for acetaminophen (1.6% vs 2.3%), antidepressants (9.6% vs 12.0%) and gabapentinoids (13.2% vs 19.0%). In this period, the adjusted odds of receiving an opioid prescription decreased (aOR = .93, 95% CI = .90-.96), while the adjusted odds of receiving antidepressant, gabapentinoid and acetaminophen prescriptions increased (antidepressants: aOR = 1.08, 95% CI = 1.03-1.13 gabapentinoids: aOR = 1.11, 95% CI = 1.06-1.17; acetaminophen: aOR = 1.10, 95% CI: 1.02-1.20). Secondary analyses stratifiying within the 2014 to 2016 and 2016 to 2018 periods revealed particular increases in prescriptions for gabapentinoids (aOR = 1.13, 95% CI = 1.05-1.21) and antidepressants (aOR = 1.23, 95% CI = 1.12-1.35) since 2016. PERSPECTIVE: These data demonstrate that physicians are increasingly turning to CDC-recommended non-opioid medications for pain management, particularly antidepressants and gabapentinoids. However, evidence for these medications' efficacy in treating numerous common pain conditions, including low back pain, remains limited.
随着阿片类药物处方量的下降，目前尚不清楚美国各地的处方疼痛治疗格局发生了怎样的变化。我们使用了2014年至2018年医疗支出健康调查中的全国代表性数据，来研究阿片类和非阿片类疼痛药物的处方趋势，这些药物包括对乙酰氨基酚、非甾体抗炎药、加巴喷丁类药物和抗抑郁药，涉及有自我报告疼痛症状的美国成年人。总体而言，从2014年到2018年，接受阿片类药物处方的参与者比例下降了（38.8%对32.8%），非甾体抗炎药的比例保持稳定（26.8%对27.7%），而对乙酰氨基酚（1.6%对2.3%）、抗抑郁药（9.6%对12.0%）和加巴喷丁类药物（13.2%对19.0%）的比例有所上升。在此期间，接受阿片类药物处方的调整后几率下降（aOR = 0.93，95% CI = 0.90 - 0.96），而接受抗抑郁药、加巴喷丁类药物和对乙酰氨基酚处方的调整后几率上升（抗抑郁药：aOR = 1.08，95% CI = 1.03 - 1.13；加巴喷丁类药物：aOR = 1.11，95% CI = 1.06 - 1.17；对乙酰氨基酚：aOR = 1.10，95% CI：1.02 - 1.20）。在2014年至2016年以及2016年至2018年期间进行的分层二级分析显示，自2016年以来，加巴喷丁类药物（aOR = 1.13，95% CI = 1.05 - 1.21）和抗抑郁药（aOR = 1.23，95% CI = 1.12 - 1.35）的处方量尤其增加。观点：这些数据表明，医生越来越多地转向疾病控制与预防中心推荐的非阿片类药物进行疼痛管理，尤其是抗抑郁药和加巴喷丁类药物。然而，这些药物在治疗包括腰痛在内的多种常见疼痛病症方面的疗效证据仍然有限。
