Halvorsen Unni, Bjørnnes Ann Kristin, Ljosaa Tone Marte
Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.
Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
J Pain Res. 2023 Apr 17;16:1285-1300. doi: 10.2147/JPR.S394878. eCollection 2023.
Opioids in chronic non-cancer pain are debated, but remain a part of the pain treatment for selected patients. Research is scarce on the relieving and adverse effects of opioids, and how to deliver opioid treatment in this patient group. This study's purpose was to assess the feasibility of a nurse-led telephone follow-up intervention for titrating or tapering opioids, including a pilot study of the intervention outcomes.
The feasibility assessment and process evaluation were performed according to the UK Medical Research Council (MRC) framework for evaluating complex interventions. A pilot study of the intervention outcomes was also performed. With a retrospective, descriptive, and longitudinal approach, we analyzed reports from 32 patients who titrated or tapered opioids. Information on demography, sleep satisfaction, health status, pain intensity/bothersomeness, opioid doses, and side effects was derived from the Oslo Pain Registry. Descriptive statistics, t-tests, and chi-square tests were used to analyze registry data.
The study findings indicate that the intervention is feasible. Areas of impact were lack of a sound theory basis, unclear allocation criteria, and inconsistent and non-validated measurement tools. Mechanisms of change were interprofessional collaboration, nurses' knowledge and competencies, predictability, and availability. Statistical analyses showed no between-groups differences in demographical-, clinical-, and pain characteristics, except those who titrated opioids were significantly older than patients tapering opioids (=0.010). All patients reported poor health and side effects at baseline. Those who tapered opioids had a significant reduction in opioid use (=0.004). Titrating opioids was associated with a significant increase in side effects (=0.038).
Considering the limitations and the strengths of the intervention, the present study indicates that the nurse-led telephone follow-up program is a feasible intervention. With the right adjustments and improvements, the intervention is eligible for a larger efficacy study.
阿片类药物在慢性非癌性疼痛治疗中的应用存在争议，但仍是部分患者疼痛治疗的一部分。关于阿片类药物的缓解效果、不良反应以及如何在该患者群体中进行阿片类药物治疗的研究较少。本研究旨在评估由护士主导的电话随访干预用于调整或减少阿片类药物剂量的可行性，包括对干预效果的初步研究。
可行性评估和过程评价按照英国医学研究理事会（MRC）评估复杂干预措施的框架进行。同时也开展了干预效果的初步研究。采用回顾性、描述性和纵向研究方法，我们分析了32例调整或减少阿片类药物剂量患者的报告。人口统计学信息、睡眠满意度、健康状况、疼痛强度/困扰程度、阿片类药物剂量和副作用等数据来自奥斯陆疼痛登记处。使用描述性统计、t检验和卡方检验分析登记处数据。
研究结果表明该干预措施是可行的。影响因素包括缺乏坚实的理论基础、分配标准不明确以及测量工具不一致且未经验证。改变机制包括跨专业协作、护士的知识和能力、可预测性和可及性。统计分析显示，除了调整阿片类药物剂量的患者比减少阿片类药物剂量的患者年龄显著更大（P = 0.010）外，两组在人口统计学、临床和疼痛特征方面无差异。所有患者在基线时均报告健康状况不佳和有副作用。减少阿片类药物剂量的患者阿片类药物使用量显著减少（P = 0.004）。调整阿片类药物剂量与副作用显著增加相关（P = 0.038）。
考虑到该干预措施的局限性和优势，本研究表明由护士主导的电话随访计划是一种可行的干预措施。经过适当调整和改进后，该干预措施有资格开展更大规模的疗效研究。
