Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada.
Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Canada.
Pharmacoepidemiol Drug Saf. 2024 Jan;33(1):e5706. doi: 10.1002/pds.5706. Epub 2023 Oct 6.
This study aimed to identify opioid consumption trajectories among persons living with chronic pain (CP) and put them in relation to patient-reported outcomes 6 months after initiating multidisciplinary pain treatment.
This study used data from the Quebec Pain Registry (2008-2014) linked to longitudinal Quebec health insurance databases. We included adults diagnosed with CP and covered by the Quebec public prescription drug insurance plan. The daily cumulative opioid doses in the first 6 months after initiating multidisciplinary pain treatment were transformed into morphine milligram equivalents. An individual-centered approach involving principal factor and cluster analyses applied to longitudinal statistical indicators of opioid use was conducted to classify trajectories. Multivariate regression models were applied to evaluate the associations between trajectory group membership and outcomes at 6-month follow-up (pain intensity, pain interference, depression, and physical and mental health-related quality of life).
We identified three trajectories of opioid consumption: "no or very low and stable" opioid consumption (n = 2067, 96.3%), "increasing" opioid consumption (n = 40, 1.9%), and "decreasing" opioid consumption (n = 39, 1.8%). Patients in the "no or very low and stable" trajectory were less likely to be current smokers, experience polypharmacy, use opioids or benzodiazepine preceding their first visit, or experience pain interference at treatment initiation. Patients in the "increasing" opioid consumption group had significantly greater depression scores at 6-month compared to patients in the "no or very low and stable" trajectory group.
Opioid consumption trajectories do not seem to be important determinants of most PROs 6 months after initiating multidisciplinary pain treatment.
本研究旨在确定慢性疼痛（CP）患者的阿片类药物消费轨迹，并将其与启动多学科疼痛治疗 6 个月后的患者报告结局（PROs）联系起来。
本研究使用了魁北克疼痛登记处（2008-2014 年）的数据，这些数据与纵向魁北克健康保险数据库相关联。我们纳入了患有 CP 并由魁北克公共处方药物保险计划承保的成年人。启动多学科疼痛治疗后 6 个月内的每日累积阿片类药物剂量转换为吗啡毫克当量。采用个体中心方法，对纵向阿片类药物使用的统计指标进行主成分和聚类分析，对轨迹进行分类。应用多元回归模型评估轨迹组别的成员与 6 个月随访时的结局（疼痛强度、疼痛干扰、抑郁以及身体和精神健康相关的生活质量）之间的关联。
我们确定了三种阿片类药物消费轨迹：“无或极低且稳定”阿片类药物消费（n=2067，96.3%）、“增加”阿片类药物消费（n=40，1.9%）和“减少”阿片类药物消费（n=39，1.8%）。“无或极低且稳定”轨迹组的患者更不可能是当前吸烟者、接受多药治疗、在首次就诊前使用阿片类药物或苯二氮䓬类药物，或在治疗开始时出现疼痛干扰。与“无或极低且稳定”轨迹组相比，“增加”阿片类药物消费组在 6 个月时的抑郁评分显著更高。
启动多学科疼痛治疗 6 个月后，阿片类药物消费轨迹似乎不是大多数 PROs 的重要决定因素。
