Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA.
Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA.
Am J Ind Med. 2024 Nov;67(11):1039-1049. doi: 10.1002/ajim.23666. Epub 2024 Sep 29.
Long-term opioid use is related to numerous harms and has uncertain efficacy for chronic, non-cancer pain. Identification of individuals at risk for long-term opioid use can help support treatment decisions. The aim of this study was to determine psychosocial factors associated with opioid use 6 months after a work-related injury.
This was a prospective observational cohort study incorporating surveys and administrative data. Eligibility included a workers' compensation claim for an injury between June 2019 and September 2021, no opioid use within 3 months before injury, and opioid use within 6 weeks after injury. The outcome was self-reported opioid use at the 6-month follow-up survey (no use, use some days, or use most or every day). Multinomial logistic regression models were used to calculate relative risk ratios (RRRs) for associations between self-reported psychosocial factors and long-term opioid use.
Of the 1724 respondents, 301 (17.5%) reported taking long-term opioids on some days and 87 (5.0%) reported taking long-term opioids on most or every day. After adjustment for sociodemographic and clinical covariates, workers reporting work fear-avoidance had a higher relative risk of opioid use most or every day, versus no opioid use at the 6-month survey, compared to those without work fear-avoidance (RRR = 1.95, 95% CI = 1.08, 3.50). Anxiety symptoms, depression symptoms, and recovery expectations were not associated with long-term opioid use after covariate adjustment.
Work fear-avoidance was associated with long-term opioid use in this study of injured workers. Addressing fears surrounding an injury and returning to work may help deter reliance on long-term opioids.
长期使用阿片类药物与许多危害有关，并且对慢性非癌性疼痛的疗效不确定。识别有长期使用阿片类药物风险的个体有助于支持治疗决策。本研究旨在确定与工作相关损伤后 6 个月阿片类药物使用相关的心理社会因素。
这是一项前瞻性观察队列研究，纳入了问卷调查和行政数据。纳入标准包括：2019 年 6 月至 2021 年 9 月期间因受伤提出工人赔偿申请、受伤前 3 个月内无阿片类药物使用史且受伤后 6 周内有阿片类药物使用史。结局为 6 个月随访调查时的自我报告阿片类药物使用情况（无使用、部分天使用或大部分或每天使用）。使用多分类逻辑回归模型计算自我报告的心理社会因素与长期阿片类药物使用之间关联的相对风险比（RRR）。
在 1724 名受访者中，301 名（17.5%）报告在部分天服用长期阿片类药物，87 名（5.0%）报告大部分或每天服用长期阿片类药物。在校正社会人口学和临床协变量后，与无工作回避恐惧的工人相比，报告工作回避恐惧的工人在 6 个月调查时更有可能出现大部分或每天使用阿片类药物的情况，而不是不使用阿片类药物（RRR=1.95，95%CI=1.08，3.50）。焦虑症状、抑郁症状和康复期望在调整协变量后与长期阿片类药物使用无关。
在这项受伤工人的研究中，工作回避恐惧与长期阿片类药物使用相关。解决对受伤的恐惧和重返工作可能有助于减少对长期阿片类药物的依赖。
