Kleinmann Barbara, Wolter Tilman
Interdisciplinary Pain Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
J Clin Med. 2022 Jan 27;11(3):647. doi: 10.3390/jcm11030647.
Chronic pain is a complex biopsychosocial phenomenon. Lifestyle, behavioral, socioeconomic, and psychosocial factors such as depression and perceived injustice are often associated with the development of chronic pain and vice versa. We sought to examine the interaction of these factors with opioid intake.
At our institution, 164 patients with chronic pain undergoing an interdisciplinary assessment within a three-month period participated in the study and completed the Injustice Experience Questionnaire (IEQ). Data regarding opioid intake, pain levels, pain diagnosis, depression, anxiety, stress, quality of life, pain-related disability, habitual well-being, occupational status, and ongoing workers compensation litigation were extracted from the patients' charts.
Approximately one-fourth of the patients used opioids. The IEQ total was significantly higher in patients using Schedule III opioids. Depression, but not the anxiety and stress scores, were significantly higher in patients using opioids. There were no significant differences regarding pain-related disability, habitual well-being, and the coded psychosocial diagnoses. In the patient group without opioids, the percentage of employed persons was significantly higher but there were no significant differences regarding work leave, pension application, or professional education.
Opioid use appears to be more closely related to psychological factors and single social determinants of pain than to somatic factors.
慢性疼痛是一种复杂的生物心理社会现象。生活方式、行为、社会经济以及心理社会因素，如抑郁和感知到的不公正，常常与慢性疼痛的发生相关，反之亦然。我们试图研究这些因素与阿片类药物摄入之间的相互作用。
在我们机构，164名在三个月内接受跨学科评估的慢性疼痛患者参与了该研究，并完成了不公正经历问卷（IEQ）。从患者病历中提取了有关阿片类药物摄入、疼痛程度、疼痛诊断、抑郁、焦虑、压力、生活质量、疼痛相关残疾、习惯性幸福感、职业状况以及正在进行的工伤赔偿诉讼等数据。
约四分之一的患者使用阿片类药物。使用III类阿片药物的患者IEQ总分显著更高。使用阿片类药物的患者抑郁得分显著更高，但焦虑和压力得分无显著差异。在疼痛相关残疾、习惯性幸福感以及编码的心理社会诊断方面无显著差异。在未使用阿片类药物的患者组中，就业人员的百分比显著更高，但在病假、养老金申请或专业教育方面无显著差异。
阿片类药物的使用似乎与疼痛的心理因素和单一社会决定因素比与躯体因素关系更为密切。
