Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
Rutgers Institute for Health, Rutgers University, New Brunswick, USA.
Psychol Med. 2024 May;54(7):1419-1430. doi: 10.1017/S003329172300332X. Epub 2023 Nov 17.
Chronic pain has been extensively explored as a risk factor for opioid misuse, resulting in increased focus on opioid prescribing practices for individuals with such conditions. Physical disability sometimes co-occurs with chronic pain but may also represent an independent risk factor for opioid misuse. However, previous research has not disentangled whether disability contributes to risk independent of chronic pain.
Here, we estimate the independent and joint adjusted associations between having a physical disability and co-occurring chronic pain condition at time of Medicaid enrollment on subsequent 18-month risk of incident opioid use disorder (OUD) and non-fatal, unintentional opioid overdose among non-elderly, adult Medicaid beneficiaries (2016-2019).
We find robust evidence that having a physical disability approximately doubles the risk of incident OUD or opioid overdose, and physical disability co-occurring with chronic pain increases the risks approximately sixfold as compared to having neither chronic pain nor disability. In absolute numbers, those with neither a physical disability nor chronic pain condition have a 1.8% adjusted risk of incident OUD over 18 months of follow-up, those with physical disability alone have an 2.9% incident risk, those with chronic pain alone have a 3.6% incident risk, and those with co-occurring physical disability and chronic pain have a 11.1% incident risk.
These findings suggest that those with a physical disability should receive increased attention from the medical and healthcare communities to reduce their risk of opioid misuse and attendant negative outcomes.
慢性疼痛已被广泛研究为阿片类药物滥用的风险因素，这导致人们更加关注有此类疾病的个体的阿片类药物处方实践。身体残疾有时与慢性疼痛同时发生，但也可能是阿片类药物滥用的独立风险因素。然而，以前的研究并未理清残疾是否独立于慢性疼痛而增加风险。
在这里，我们估计在医疗补助计划登记时患有身体残疾和同时存在慢性疼痛状况的情况下，与随后的 18 个月内非老年成年医疗补助受益人的阿片类药物使用障碍（OUD）和非致命性、非故意阿片类药物过量事件的发生率之间存在独立和联合调整关联（2016-2019 年）。
我们发现强有力的证据表明，身体残疾使发生 OUD 或阿片类药物过量的风险增加了约一倍，而身体残疾与慢性疼痛同时存在的风险比既没有慢性疼痛也没有残疾的风险增加了约六倍。在绝对数字方面，既没有身体残疾也没有慢性疼痛状况的人在 18 个月的随访中，调整后发生 OUD 的风险为 1.8%，仅有身体残疾的人发生 OUD 的风险为 2.9%，仅有慢性疼痛的人发生 OUD 的风险为 3.6%，同时患有身体残疾和慢性疼痛的人发生 OUD 的风险为 11.1%。
这些发现表明，身体残疾者应得到医疗和医疗保健界的更多关注，以降低他们阿片类药物滥用和随之而来的不良后果的风险。
