Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Osteoarthritis Cartilage. 2022 Nov;30(11):1536-1544. doi: 10.1016/j.joca.2022.08.001. Epub 2022 Aug 18.
To investigate changes in opioid use after supervised exercise therapy and patient education among knee or hip osteoarthritis patients with chronic opioid use.
In this cohort study, we linked data from the Good Life with osteoArthritis in Denmark register (GLA:D®; standardised treatment program for osteoarthritis; January 2013 to November 2018) with national health registries. Among 35,549 patients, 1,262 were classified as chronic opioid users based on amount and temporal distribution of dispensed opioids the year before the intervention. We investigated changes in opioid use, measured as mg oral morphine equivalents (OMEQs), from the year before the intervention to the year after using generalized estimating equations.
We found a 10% decrease in mg OMEQs from the year before to the year after the intervention (incidence rate ratio [IRR]: 0.90, 95% confidence interval [CI]: 0.86, 0.94). Additional analyses suggested this decrease to be mainly attributable to regulatory actions targeting opioid prescribing during the study period (IRR among patients participating in the intervention before: 0.98 [95% CI: 0.89, 1.07] vs after: 0.83 [0.74, 0.93] regulatory actions). In a random general population sample of matched chronic opioid users, a similar opioid use pattern was observed over time, further supporting the impact of regulatory actions on the opioid use in the study population.
Among patients with knee or hip osteoarthritis and chronic opioid use, a standardised treatment program did not change opioid use when regulatory changes in opioid prescribing were taken into account.
调查膝关节或髋关节骨关节炎慢性阿片类药物使用者接受监督运动治疗和患者教育后阿片类药物使用的变化。
在这项队列研究中，我们将来自丹麦骨关节炎生活质量登记处（GLA:D®；骨关节炎标准化治疗方案；2013 年 1 月至 2018 年 11 月）的数据与国家健康登记处进行了关联。在 35549 名患者中，根据干预前一年开具的阿片类药物的数量和时间分布，有 1262 名患者被归类为慢性阿片类药物使用者。我们使用广义估计方程调查了从干预前一年到干预后一年阿片类药物使用的变化，以口服吗啡等效剂量（mg OMEQ）衡量。
我们发现，从干预前一年到干预后一年，mg OMEQ 减少了 10%（发生率比[IRR]：0.90，95%置信区间[CI]：0.86，0.94）。进一步的分析表明，这种减少主要归因于研究期间针对阿片类药物处方的监管行动（在干预前参加的患者中，IRR 为 0.98[95%CI：0.89，1.07]，而在监管行动后，IRR 为 0.83[0.74，0.93]）。在一个匹配的慢性阿片类药物使用者的随机一般人群样本中，观察到随着时间的推移，阿片类药物使用模式相似，这进一步支持了监管行动对研究人群中阿片类药物使用的影响。
在膝关节或髋关节骨关节炎且慢性阿片类药物使用者中，当考虑到阿片类药物处方的监管变化时，标准化治疗方案并未改变阿片类药物的使用。
