Ramirez Medina Carlos Raul, Lyon Max, Davies Elinor, McCarthy David, Reid Vanessa, Khanna Ashwin, Jani Meghna
Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, United Kingdom.
The University of Manchester Medical School, Manchester, United Kingdom.
Pain. 2025 Mar 1;166(3):656-666. doi: 10.1097/j.pain.0000000000003402. Epub 2024 Oct 24.
Prescription opioids for noncancer pain in the United Kingdom have increased over the past 2 decades, alongside associated harms. Policies addressing opioid prescribing must be tailored to individual patient needs with specific disease systems. The aim of this study was to evaluate clinical conditions associated with new opioid initiation in noncancer pain using nationally representative UK data. Primary care electronic health records from January 1, 2006, to September 31, 2021, were used from the Clinical Research Practice Datalink to identify incident opioid prescriptions. Patient histories were reviewed using code lists for opioid-related conditions with a 5-year look-back for chronic conditions and a 1-year look-back for surgical indications before opioid initiation. In total, 3,030,077 new opioid use episodes in 2,027,402 patients were identified, with 61% being women, 77% aged 45 years and older, and 48% from the highest deprivation quintile. Ten systems associated with opioid initiation were identified, which were not mutually exclusive, as patients could have opioids prescribed for multiple indications. The most common were musculoskeletal (80.8%), respiratory (57.6%), infections (30.4%), trauma/injury (20.4%), neurology (19.9%), and postsurgical indications (5.5%). Osteoarthritis (60.7%) and low back pain (41.0%) were the most frequent musculoskeletal conditions. Orthopedic surgeries accounted for 41.2% of all postsurgical indications. This is the first study in the United Kingdom evaluating large-scale national data to assess indications associated with opioid initiation. Nearly 3 quarters of new opioid prescriptions for noncancer pain were in patients with musculoskeletal conditions, often for conditions with limited evidence for opioid efficacy. These findings could inform targeted interventions and future policies to support nonpharmacological interventions in the most common conditions where opioid harms outweigh benefits.
在过去20年里，英国用于非癌性疼痛的处方阿片类药物有所增加，同时也带来了相关危害。针对阿片类药物处方的政策必须根据患有特定疾病的个体患者需求进行调整。本研究的目的是利用具有全国代表性的英国数据，评估与非癌性疼痛中开始使用新阿片类药物相关的临床状况。使用临床研究实践数据链中2006年1月1日至2021年9月31日的初级保健电子健康记录来确定阿片类药物的新处方。使用与阿片类药物相关疾病的代码列表回顾患者病史，对慢性病进行5年回顾，对阿片类药物开始使用前的手术指征进行1年回顾。总共在2,027,402名患者中确定了3,030,077次新的阿片类药物使用事件，其中61%为女性，77%年龄在45岁及以上，48%来自最贫困的五分之一人群。确定了与阿片类药物开始使用相关的10个系统，这些系统并非相互排斥，因为患者可能因多种指征而开具阿片类药物。最常见的是肌肉骨骼系统（80.8%）、呼吸系统（57.6%）、感染（30.4%）、创伤/损伤（20.4%）、神经学（19.9%）和术后指征（5.5%）。骨关节炎（60.7%）和腰痛（41.0%）是最常见的肌肉骨骼疾病。骨科手术占所有术后指征的41.2%。这是英国第一项评估大规模全国数据以评估与阿片类药物开始使用相关指征的研究。近四分之三的非癌性疼痛新阿片类药物处方用于患有肌肉骨骼疾病的患者，这些疾病通常阿片类药物疗效证据有限。这些发现可为有针对性的干预措施和未来政策提供参考，以支持在阿片类药物危害大于益处的最常见情况下进行非药物干预。
