Schnitzer Thomas J, Robinson Rebecca L, Viktrup Lars, Cappelleri Joseph C, Bushmakin Andrew G, Tive Leslie, Berry Mia, Walker Chloe, Jackson James
Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Value, Evidence and Outcomes, Eli Lilly and Company, Indianapolis, IN 46285, USA.
J Clin Med. 2023 Apr 6;12(7):2733. doi: 10.3390/jcm12072733.
Patients often take opioids to relieve osteoarthritis (OA) pain despite limited benefits and potential harms. This study aimed to compare cross-sectional perspectives of patients that were taking prescription opioid (N = 471) or nonopioid medications (N = 185) for OA in terms of satisfaction, expectations of effectiveness, and concerns. Patients prescribed opioids (>7 days) reported more prior treatments (2.47 vs. 1.74), greater mean pain intensity (5.47 vs. 4.11), and worse quality of life (EQ-5D-5L index value mean 0.45 vs. 0.71) than patients prescribed nonopioid medications (all < 0.0001). Based on linear regression models adjusting for demographics and pain intensity, patients prescribed opioids were less satisfied with overall regimen (3.40 vs. 3.67, = 0.0322), had less belief that medications were meeting effectiveness expectations (2.72 vs. 3.13, < 0.0001), and had more concerns about treatments being "not very good" (3.66 vs. 3.22, = 0.0026) and addiction (3.30 vs. 2.65, < 0.0001) than patients prescribed nonopioid regimens. When the models were replicated for subgroups with ≥30 days' medication regimen duration, the findings were consistent with the main analyses. Patients have concerns about the risk of opioid addiction, but those with greater disease burden and more prior treatments continue taking opioid regimens.
尽管益处有限且存在潜在危害，但患者仍常服用阿片类药物来缓解骨关节炎（OA）疼痛。本研究旨在比较服用处方阿片类药物（N = 471）或非阿片类药物（N = 185）治疗OA的患者在满意度、疗效期望和担忧方面的横断面观点。与服用非阿片类药物的患者相比，服用阿片类药物（>7天）的患者报告的既往治疗次数更多（2.47比1.74），平均疼痛强度更大（5.47比4.11），生活质量更差（EQ-5D-5L指数值平均为0.45比0.71）（所有P均<0.0001）。基于调整了人口统计学和疼痛强度的线性回归模型，服用阿片类药物的患者对总体治疗方案的满意度较低（3.40比3.67，P = 0.0322），对药物达到疗效期望的信心较低（2.72比3.13，P<0.0001），并且比服用非阿片类治疗方案的患者更担心治疗“不太好”（3.66比3.22，P = 0.0026）和成瘾问题（3.30比2.65，P<0.0001）。当对药物治疗方案持续时间≥30天的亚组重复这些模型时，结果与主要分析一致。患者担心阿片类药物成瘾的风险，但疾病负担较重且既往治疗次数较多的患者仍继续服用阿片类治疗方案。
