Onishi Eriko, Lucas Jennifer A, Maeno Tetsuhiro, Bailey Steffani R
From the Department of Family Medicine, Oregon Health & Science University, Portland, OR (EO, JAL, SRB); Department of Primary Care and Medical Education, University of Tsukuba, Japan (TM).
J Am Board Fam Med. 2023 Apr 3;36(2):267-276. doi: 10.3122/jabfm.2022.220311R2. Epub 2023 Mar 22.
Limited studies are available on patients' perspectives regarding opioid-related awareness, beliefs, and pain management in primary care settings in the US. Pain catastrophizing (PC) is a cascade of negative thoughts and emotions in response to actual or anticipated pain. High PC is 1 of the strongest predictors of negative pain outcomes.
A cross-sectional survey was administered at Family Medicine clinics in the Pacific Northwest, November 2018-January 2019. Logistic regression was used to model the adjusted odds of participants' awareness and beliefs on opioid epidemic issues, side effects/risks, and general beliefs by opioid prescription expectations and PC.
108 participants completed the survey. Compared with participants with low PC, high PC participants were 74% less likely to be aware of opioid epidemic issues (OR = 0.26, , 95% CI:0.10-0.67), 62% less likely to be aware of opioid side effects/risks (OR = 0.38 , 95% CI: 0.15-0.96) and had 2.4 times increased odds of holding more positive beliefs about opioids and/or stronger beliefs regarding pain control, yet the latter did not reach statistical significance (OR = 2.40 , 95% CI: 0.89-6.47).
Significant gaps existed among our participants with high PC in their awareness of opioid epidemic issues and side effects/risks compared with their low PC counterparts. They may also carry positive beliefs regarding opioids and pain-control in general. In any pain care, it seems important to identify patients with high pain catastrophizing. Doing so may facilitates exploration of their beliefs and expectations regarding pain management and aids in tailoring individualized treatment and prevent adverse side effects.
关于美国初级保健机构中患者对阿片类药物相关认知、信念及疼痛管理的观点的研究有限。疼痛灾难化（PC）是对实际或预期疼痛产生的一系列消极思想和情绪。高PC是负面疼痛结果最强的预测因素之一。
2018年11月至2019年1月在太平洋西北地区的家庭医学诊所进行了一项横断面调查。采用逻辑回归模型来分析参与者对阿片类药物流行问题、副作用/风险的认知和信念，以及按阿片类药物处方期望和PC划分的一般信念的调整后比值比。
108名参与者完成了调查。与低PC参与者相比，高PC参与者知晓阿片类药物流行问题的可能性低74%（比值比=0.26，95%置信区间：0.10-0.67），知晓阿片类药物副作用/风险的可能性低62%（比值比=0.38，95%置信区间：0.15-0.96），对阿片类药物持有更积极信念和/或对疼痛控制持有更强信念的可能性增加了2.4倍，但后者未达到统计学显著性（比值比=2.40，95%置信区间：0.89-6.47）。
与低PC参与者相比，我们的高PC参与者在阿片类药物流行问题及副作用/风险的认知方面存在显著差距。他们总体上可能也对阿片类药物和疼痛控制持有积极信念。在任何疼痛护理中，识别高疼痛灾难化的患者似乎都很重要。这样做可能有助于探究他们对疼痛管理的信念和期望，并有助于制定个性化治疗方案以及预防不良副作用。
