Faculty of Medicine, Division of Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Department of Research and Development, Skåne University Hospital, Lund, Sweden.
Eur J Pain. 2023 Aug;27(7):848-859. doi: 10.1002/ejp.2114. Epub 2023 Apr 7.
Prolonged opioid use (more than 90 days) after injury puts the patient at risk for adverse effects. We investigated the patterns of opioid prescription after distal radius fracture and the effect of pre- and post-fracture factors on the risk for prolonged use.
This register-based cohort study uses routinely collected health care data, including purchases of prescription opioids, in the county of Skåne, Sweden. 9369 adult patients with a radius fracture diagnosed 2015-2018 were followed for 1 year after fracture. We calculated proportions of patients with prolonged opioid use, both in total and according to different exposures. Using modified Poisson regression, we calculated adjusted risk ratios for the following exposures: previous opioid use, mental illness, consultation for pain, surgery for distal radius fracture and occupational/physical therapy after fracture.
Prolonged opioid use (4-6 months after fracture) was found in 664 (7.1%) of the patients. A previous, but discontinued, regular use of opioids up to 5 years before fracture increased the risk compared to opioid-naïve patients. Both regular and non-regular opioid use the year before fracture increased the risk. The risk was also higher for patients with mental illness, and those who were treated with surgery, we found no significant effect of pain consultation in previous year. Occupational/physical therapy lowered the risk for prolonged use.
Considering history of mental illness and previous opioid use while promoting rehabilitation can be important to prevent prolonged opioid use after distal radius fracture.
We show that a common injury such as distal radius fracture can be a gateway to prolonged opioid use, especially among patients with previous history of opioid use or mental illness. Importantly, previous opioid use as far back as 5 years earlier greatly increases the risk of regular use after the reintroduction of opioids. Considering past use is important when planning treatment with opioids. Occupational or physical therapy after injury is associated with lower risk of prolonged use and should be encouraged.
受伤后长期（超过 90 天）使用阿片类药物会使患者面临不良反应的风险。我们研究了桡骨远端骨折后阿片类药物的处方模式，并探讨了骨折前和骨折后因素对长期使用阿片类药物风险的影响。
这是一项基于登记的队列研究，使用瑞典斯科讷省常规收集的医疗保健数据，包括处方阿片类药物的购买情况。2015 年至 2018 年间，9369 名成年桡骨骨折患者接受了为期 1 年的随访。我们计算了不同暴露因素下的患者长期使用阿片类药物的比例，包括总比例和不同暴露因素下的比例。使用校正泊松回归，我们计算了以下暴露因素的校正风险比：既往阿片类药物使用、精神疾病、疼痛咨询、桡骨远端骨折手术以及骨折后职业/物理治疗。
在 664 名（7.1%）患者中发现了长期使用阿片类药物（骨折后 4-6 个月）。与未使用过阿片类药物的患者相比，骨折前 5 年内曾使用过阿片类药物（但已停药）的患者风险增加。骨折前一年的常规和非常规阿片类药物使用均增加了风险。我们发现，患有精神疾病的患者和接受手术治疗的患者的风险更高，而在之前一年中进行疼痛咨询的患者风险则没有显著增加。职业/物理治疗降低了长期使用的风险。
在促进康复的过程中，考虑精神疾病史和之前的阿片类药物使用情况可能对预防桡骨远端骨折后长期使用阿片类药物很重要。
我们表明，常见的损伤，如桡骨远端骨折，可能是长期使用阿片类药物的一个途径，特别是对于有既往阿片类药物使用或精神疾病史的患者。重要的是，早在 5 年前的阿片类药物使用史大大增加了再次使用阿片类药物后常规使用的风险。在计划使用阿片类药物治疗时，考虑过去的使用情况很重要。受伤后进行职业或物理治疗与较低的长期使用风险相关，应予以鼓励。
