Shermon Suzanna, Fazio Kimberly M, Shim Richard, Abd-Elsayed Alaa, Kim Chong H
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.
Brain Sci. 2023 Jun 30;13(7):1012. doi: 10.3390/brainsci13071012.
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.
We conducted a retrospective case-control study.
A total of 2510 CRPS patients and 2510 demographic-matched controls participated in this study.
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.
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%).
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.
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。
我们进行了一项回顾性病例对照研究。
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。
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。
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)。
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。