环苯扎林在肌肉骨骼腰痛中的应用：2007-2019 年全国医院门诊医疗调查数据分析。

Cyclobenzaprine utilization for musculoskeletal back pain: Analysis of 2007-2019 National Hospital Ambulatory Medical Care Survey Data.

机构信息

Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.

出版信息

Am J Emerg Med. 2023 Jun;68:106-111. doi: 10.1016/j.ajem.2023.03.025. Epub 2023 Mar 18.

DOI:10.1016/j.ajem.2023.03.025

PMID:36965470

Abstract

BACKGROUND

With musculoskeletal back pain being one of the most common presentations in the emergency department, evidence-based management strategies are needed to address such complaints. Along with other medications, cyclobenzaprine is a muscle relaxant commonly prescribed for patients complaining of musculoskeletal pain, in particular, pain associated with muscle spasms. However, with recent literature questioning its efficacy, the role of cyclobenzaprine use in patients with musculoskeletal back pain remains unclear.

OBJECTIVES

The objective of the study is to investigate trends of cyclobenzaprine utilization among patients presenting to the emergency department (ED) in the United States.

METHODS

This is a retrospective cohort review of data obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) between 2007 and 2019. We analyzed ED visits of patients 18 years and older. Visits during which cyclobenzaprine was administered in the ED or prescribed at discharge were identified. Trends were described using a time series analysis of patients' visits who received administration and prescriptions of cyclobenzaprine.

RESULTS

Between 2007 and 2019, we identified an estimated 1.35 billion ED visits, 57.2% (772.6 million) were female. From that sample, 2.4% (32.7 million) of all visits received cyclobenzaprine prescription in the ED only, and 0.5% (6.6 million) of total visits were both given the drug in the ED and were prescribed the drug at discharge). Overall trend analysis shows a slight decrease in annual percentages of cyclobenzaprine administration and prescriptions during the study period. Visits of certain subgroups: 26-44 years, white showed relatively higher percentages of administration and prescription of cyclobenzaprine.

CONCLUSIONS

Although there was a slight decrease, our study still shows significant cyclobenzaprine utilization in the ED, despite conflicting evidence demonstrating efficacy for patients with musculoskeletal complaints and the concern for adverse effects. Additional studies are needed to examine its overall effectiveness and risk-benefit analysis in treating patients with such conditions.

摘要

背景

肌肉骨骼腰背疼痛是急诊科最常见的就诊原因之一，因此需要基于证据的管理策略来处理这些问题。除了其他药物外，环苯扎林是一种肌肉松弛剂，常被用于治疗肌肉骨骼疼痛的患者，尤其是与肌肉痉挛相关的疼痛。然而，最近的文献对其疗效提出了质疑，因此环苯扎林在肌肉骨骼腰背疼痛患者中的使用作用仍不清楚。

目的

本研究旨在调查美国急诊科（ED）就诊患者中环苯扎林使用的趋势。

方法

这是一项对 2007 年至 2019 年期间国家医院门诊医疗调查（NHAMCS）中获取的数据进行的回顾性队列研究。我们分析了年龄在 18 岁及以上的 ED 就诊患者。确定了在 ED 中给予环苯扎林或出院时开具环苯扎林处方的就诊。使用接受环苯扎林给药和处方的患者就诊的时间序列分析来描述趋势。

结果

在 2007 年至 2019 年间，我们确定了约 13.5 亿次 ED 就诊，其中 57.2%（7726 万）为女性。在该样本中，2.4%（3270 万）的所有就诊在 ED 中仅接受了环苯扎林处方，0.5%（660 万）的总就诊在 ED 中既接受了该药物治疗，又开具了该药物的出院处方）。总体趋势分析显示，在研究期间，环苯扎林给药和处方的年百分比略有下降。某些亚组就诊：26-44 岁，白人接受环苯扎林给药和处方的比例相对较高。