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复杂性区域疼痛综合征的处方趋势:一项回顾性病例对照研究。

Prescription Trends in Complex Regional Pain Syndrome: A Retrospective Case-Control Study.

作者信息

Shermon Suzanna, Fazio Kimberly M, Shim Richard, Abd-Elsayed Alaa, Kim Chong H

机构信息

MetroHealth Medical Center, Case Western Reserve University, 4229 Pearl Road, Cleveland, OH 44109, USA.

School of Medicine, Case Western Reserve University, Cleveland, OH 44109, USA.

出版信息

Brain Sci. 2023 Jun 30;13(7):1012. doi: 10.3390/brainsci13071012.

Abstract

OBJECTIVE

The objective of this study was to evaluate discrepancies in prescription trends for analgesic medications in complex regional pain syndrome (CRPS) patients based on recommendations in the literature.

DESIGN

We conducted a retrospective case-control study.

SUBJECTS

A total of 2510 CRPS patients and 2510 demographic-matched controls participated in this study.

METHODS

The SlicerDicer feature in Epic was used to find patients diagnosed with CRPS I or II between January 2010 and November 2022. An equal number of age-, gender-, and race-matched controls without a CRPS diagnosis were retracted from Epic. General and CRPS-associated prescription frequencies for the following classes were retrieved for both cases and controls: benzodiazepines, bisphosphonates, calcitonin, capsaicin, neuropathic pain medications, NSAIDs, opioids, and steroids.

RESULTS

A total of 740 (29%) CRPS patients and 425 (17%) controls were prescribed benzodiazepines (95% CI 0.1-0.15), 154 (6.1%) CRPS patients and 52 (2.1%) controls were prescribed capsaicin (95% CI 0.03-0.05), 1837 (73%) CRPS patients and 927 (37%) controls were prescribed neuropathic pain medications (95% CI 0.05-0.34), 1769 (70%) CRPS patients and 1217 (48%) controls were prescribed opioids (95% CI 0.19-0.25), 1095 (44%) CRPS patients and 1217 (48%) controls were prescribed steroids (95% CI 0.08-0.14), and 1638 (65%) CRPS patients and 1765 (70%) controls were prescribed NSAIDs (95% CI -0.08-0.02), < 0.001 for all classes. With CRPS-associated prescriptions, (95% CI 0.05-0.16, < 0.001) more CRPS patients were prescribed opioids (N = 398, 59%) than controls (N = 327, 49%).

CONCLUSIONS

CRPS is difficult to treat with significant variance in suggested treatment modalities. Based on the results of our study, there is a divergence between some published recommendations and actual practice.

摘要

目的

本研究的目的是根据文献中的建议,评估复杂区域疼痛综合征(CRPS)患者镇痛药物处方趋势的差异。

设计

我们进行了一项回顾性病例对照研究。

研究对象

共有2510例CRPS患者和2510例人口统计学匹配的对照参与了本研究。

方法

使用Epic中的SlicerDicer功能查找2010年1月至2022年11月期间被诊断为I型或II型CRPS的患者。从Epic中提取相同数量的年龄、性别和种族匹配但未诊断为CRPS的对照。检索病例组和对照组以下各类药物的一般处方频率和与CRPS相关的处方频率:苯二氮䓬类、双膦酸盐、降钙素、辣椒素、神经性疼痛药物、非甾体抗炎药、阿片类药物和类固醇。

结果

共有740例(29%)CRPS患者和425例(17%)对照被开具苯二氮䓬类药物(95%CI 0.1 - 0.15),154例(6.1%)CRPS患者和52例(2.1%)对照被开具辣椒素(95%CI 0.03 - 0.05),1837例(73%)CRPS患者和927例(37%)对照被开具神经性疼痛药物(95%CI 0.05 - 0.34),1769例(70%)CRPS患者和1217例(48%)对照被开具阿片类药物(95%CI 0.19 - 0.25),1095例(44%)CRPS患者和1217例(48%)对照被开具类固醇(95%CI 0.08 - 0.14),1638例(65%)CRPS患者和1765例(70%)对照被开具非甾体抗炎药(95%CI -0.08 - 0.02),所有类别差异均<0.0

01。在与CRPS相关的处方方面,开具阿片类药物的CRPS患者(N = 398,59%)多于对照(N = 327,49%)(95%CI 0.05 - 0.16,<0.001)。

结论

CRPS难以治疗,建议的治疗方式存在显著差异。根据我们的研究结果,一些已发表的建议与实际临床实践之间存在差异。

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