长期与短期阿片类药物治疗纤维肌痛综合征与抑郁、睡眠障碍和自杀意念风险的关系：一项基于人群的倾向评分匹配队列研究。

Long versus short-term opioid therapy for fibromyalgia syndrome and risk of depression, sleep disorders and suicidal ideation: a population-based, propensity-weighted cohort study.

机构信息

FISABIO, Valencia, Spain.

Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Valencia, Spain.

出版信息

RMD Open. 2024 Sep 23;10(3):e004466. doi: 10.1136/rmdopen-2024-004466.

DOI:10.1136/rmdopen-2024-004466

PMID:39313306

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11428988/

Abstract

OBJECTIVE

Fibromyalgia syndrome (FMS) is characterised by widespread pain and is associated with mood disorders such as depression as well as poor sleep quality. These in turn have been linked to increased risk of suicidal ideation. Clinical guidelines generally do not recommended opioids in FMS, but they are routinely prescribed to a considerable proportion of FMS patients. We assessed the association of long-term opioid prescription for FMS with risk of depression, sleep disorders and suicidal ideation, when compared with short-term opioid use.

METHODS

Retrospective cohort study combing several population-wide databases covering a population of five million inhabitants, including all adults who received an initial opioid prescription from 2014 to 2018 specifically prescribed for FMS. We examined the occurrence of depression, sleep disorders or suicidal ideation outcomes in patients with an initial long-term opioid prescription (>90 days) versus those who received a short-term treatment (<29 days). We employed multivariable Cox regression modelling and inverse probability of treatment weighting based on propensity scores and we performed several sensitivity analyses.

RESULTS

10 334 patients initiated short-term (8309, 80.40%) or long-term (2025, 19.60%) opioids for FMS. In main adjusted analyses, long-term opioid use was associated with an increased risk for depression (HR: 1.58, 95% CI 1.29 to 1.95) and sleep disorder (HR: 1.30, 95% CI 1.09 to 1.55) but not with suicidal ideation (HR: 1.59, 95% CI 0.96 to 2.62). In models assessing outcomes since day 90, an increased risk for suicidal ideation was observed (HR: 1.76, 95% CI 1.05 to 2.98).

CONCLUSION

These findings suggest that continued opioid use for 90 days or more may aggravate depression and sleep problems in patients with FMS when compared with patterns of short-term treatment.

摘要

目的

纤维肌痛综合征（FMS）的特征是广泛疼痛，并与情绪障碍如抑郁以及睡眠质量差有关。反过来，这些又与自杀意念的风险增加有关。临床指南一般不建议在 FMS 中使用阿片类药物，但它们经常被开给相当一部分 FMS 患者。我们评估了与短期使用阿片类药物相比，长期开处 FMS 阿片类药物与抑郁、睡眠障碍和自杀意念风险的关联。

方法

回顾性队列研究结合了几个涵盖 500 万居民的全人群数据库，包括所有在 2014 年至 2018 年期间首次接受特定用于 FMS 的阿片类药物初始处方的成年人。我们检查了患有初始长期阿片类药物处方（>90 天）的患者与接受短期治疗（<29 天）的患者的抑郁、睡眠障碍或自杀意念结果的发生情况。我们使用多变量 Cox 回归模型和基于倾向评分的治疗反概率加权，并进行了几项敏感性分析。

结果

10334 名患者开始短期（8309 人，80.40%）或长期（2025 人，19.60%）阿片类药物治疗 FMS。在主要调整分析中，长期使用阿片类药物与抑郁（HR：1.58，95%CI 1.29 至 1.95）和睡眠障碍（HR：1.30，95%CI 1.09 至 1.55）的风险增加相关，但与自杀意念无关（HR：1.59，95%CI 0.96 至 2.62）。在评估第 90 天以后结果的模型中，观察到自杀意念的风险增加（HR：1.76，95%CI 1.05 至 2.98）。