Salmasi Vafi, Nelson Lorene M, Hong Juliette, Mackey Sean C
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.
Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, United States.
Front Pain Res (Lausanne). 2022 Nov 24;3:1015605. doi: 10.3389/fpain.2022.1015605. eCollection 2022.
Opioids have been commonly used to treat chronic pain, but they are associated with significant morbidity and mortality. Cannabis has been advocated as an alternative; however, a growing number of patients are now using a combination of opioid and cannabis and the impact of this combination is not well-studied.
We characterized use of opioid and/or cannabis in patients with chronic pain; and compared utilization of healthcare resources.
We conducted a cross-sectional study to determine if measures of physical, psychological and social functioning differed among patients according to whether they used opioids and/or cannabis. We used our learning healthcare system - CHOIR - to capture NIH Patient Reported Outcomes Measure Information System surveys, and legacy pain and treatment specific questions.
Patients who report use of opioid and/or cannabis experience higher levels of physical, psychological and social distress. After adjusting for inversed weight of propensity scores, they have higher odds of visiting an emergency room, staying overnight at the hospital, and visiting a physician.
Our results show that use of opioid and/or cannabis is associated with worse baseline characteristics and outcomes. Our study however cannot determine if worse outcomes are due to the opioids and/or cannabis or simply that these patients are worse off before using opioids and/or cannabis. Thus, it is important to characterize the trajectory of these patients in a prospective longitudinal study.
阿片类药物一直被广泛用于治疗慢性疼痛，但它们会引发严重的发病和死亡风险。大麻已被提倡作为一种替代药物；然而，现在越来越多的患者同时使用阿片类药物和大麻，这种联合使用的影响尚未得到充分研究。
我们对慢性疼痛患者使用阿片类药物和/或大麻的情况进行了特征描述，并比较了医疗资源的利用情况。
我们进行了一项横断面研究，以确定根据患者是否使用阿片类药物和/或大麻，其身体、心理和社会功能指标是否存在差异。我们利用我们的学习型医疗系统——CHOIR——来收集美国国立卫生研究院患者报告结局测量信息系统的调查，以及遗留的疼痛和治疗特定问题。
报告使用阿片类药物和/或大麻的患者在身体、心理和社会困扰方面的程度更高。在对倾向得分的倒数权重进行调整后，他们去急诊室就诊、在医院过夜以及看医生的几率更高。
我们的结果表明，使用阿片类药物和/或大麻与更差的基线特征和结局相关。然而，我们的研究无法确定更差的结局是由于阿片类药物和/或大麻，还是仅仅因为这些患者在使用阿片类药物和/或大麻之前情况就更糟。因此，在前瞻性纵向研究中对这些患者的病程进行特征描述很重要。
