Miller-Matero Lisa R, Chohan Sikander, Gavrilova Lyubov, Hecht Leah M, Autio Kirsti, Tobin Erin T, Ahmedani Brian K
Behavioral Health, Henry Ford Health System, Detroit, Michigan, USA.
Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA.
Subst Use Misuse. 2022;57(9):1492-1496. doi: 10.1080/10826084.2022.2096239. Epub 2022 Jul 4.
Given the risks of opioids for pain management, we need nonpharmacological interventions that patients will engage in and that can reduce opioid use. The purpose was to examine whether offering a psychological intervention in primary care can engage patients receiving opioids for pain management and to explore whether the intervention influences opioid use.
This was a secondary analysis of a pilot randomized controlled trial (RCT) of a 5-session psychological intervention in primary care for chronic pain. Patients with chronic pain (N = 220) were approached to enroll in the RCT. Electronic health records were reviewed to determine whether patients were prescribed opioids or pain medications at the time they were approached about the RCT and the 6-months following the intervention.
Enrollees and non-enrollees had similar rates of opioid prescriptions, morphine milligram equivalent dose of opioids, and rates of other pain medication prescriptions (p> .05). However, no males with an opioid prescription enrolled. Though not significant, those in the intervention had lower odds of having an opioid prescription 6 months following the intervention (p= .09, OR= .32). Those randomized to the intervention had lower odds of having a non-opioid pain medication prescription (p= .01, OR= .17).
Having an opioid prescription did not interfere with enrollment, suggesting that primary care may be useful for engaging patients on opioids in a psychological treatment for chronic pain. However, this may be true for women, and not men. This intervention also showed promise for decreasing opioid use and warrants further study.
鉴于阿片类药物用于疼痛管理存在风险，我们需要患者能够参与的非药物干预措施，以减少阿片类药物的使用。本研究旨在探讨在初级保健中提供心理干预是否能让接受阿片类药物治疗疼痛的患者参与进来，并探究该干预措施是否会影响阿片类药物的使用。
这是一项对初级保健中针对慢性疼痛的为期5节心理干预的试点随机对照试验（RCT）的二次分析。研究人员邀请慢性疼痛患者（N = 220）参与RCT。研究人员查阅电子健康记录，以确定患者在被邀请参与RCT时以及干预后的6个月内是否被开具了阿片类药物或止痛药物。
参与者和非参与者的阿片类药物处方率、阿片类药物的吗啡毫克当量剂量以及其他止痛药物处方率相似（p>0.05）。然而，没有开具阿片类药物处方的男性参与研究。虽然差异不显著，但干预组患者在干预后6个月开具阿片类药物处方的几率较低（p = 0.09，OR = 0.32）。随机分配到干预组的患者开具非阿片类止痛药物处方的几率较低（p = 0.01，OR = 0.17）。
开具阿片类药物处方并不影响参与研究，这表明初级保健可能有助于让使用阿片类药物的患者参与慢性疼痛的心理治疗。然而，这可能仅适用于女性，而不适用于男性。该干预措施在减少阿片类药物使用方面也显示出前景，值得进一步研究。
