阿片类药物减量与疼痛相关的急诊科就诊、住院和初级保健就诊的关联：一项回顾性队列研究。
Association of opioid tapering with pain-related emergency department visits, hospitalizations, and primary care visits: a retrospective cohort study.
作者信息
Magnan Elizabeth, Tancredi Daniel J, Xing Guibo, Agnoli Alicia, Tseregounis I E, Fenton Joshua J
机构信息
Department of Family and Community Medicine, University of California, Davis, Sacramento, CA 95817, United States.
Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA 95817, United States.
出版信息
Pain Med. 2025 Apr 1;26(4):199-206. doi: 10.1093/pm/pnae121.
OBJECTIVE
Tapering of chronic opioids has increased, with subsequent reports of exacerbated pain among patients who tapered. We aimed to evaluate the association between opioid dose tapering and subsequent pain-related healthcare utilization (emergency department [ED] visits, hospitalizations and primary care visits).
DESIGN, SETTING, AND SUBJECTS: We conducted a retrospective cohort study from years 2015-2019 using data from the Optum Labs Data Warehouse that contains de-identified retrospective administrative claims data for commercial and Medicare Advantage enrollees in the United States. Adults aged ≥18 years who were prescribed stable doses of opioids, ≥50 morphine milligram equivalents (MME)/day, during a 12-month baseline period.
METHODS
Tapering was defined as ≥15% relative reduction in mean daily opioid dose during one of 6 overlapping 60-day periods. Tapered patient-periods were subclassified as tapered-and-continued (MME > 0) vs tapered-and-discontinued (MME = 0). We modeled monthly counts of visits for pain diagnoses up to 12 months after cohort entry using negative binomial regression as a function of tapering, baseline utilization, and patient level-covariates.
RESULTS
Among 47 033 patients, 13 793 patients tapered. Compared to no taper, any taper was associated with more ED visits for pain (adjusted incidence rate ratio [aIRR] 1.21, 95% confidence interval [CI]: 1.11-1.30), tapered then continued status was associated with more ED visits (aIRR 1.23, CI: 1.14-1.32) and hospitalizations (aIRR 1.14, CI: 1.03-1.27) f-or pain, and tapered-and-discontinued was associated with fewer primary care visits for pain (aIRR 0.68, CI: 0.61-0.76).
CONCLUSIONS
These associations suggest that opioid tapering may lead to increased emergency and hospital utilization for acute pain and possibly a decreased perceived need for primary care for those whose opioids were discontinued.
目的
慢性阿片类药物的减量使用有所增加，随后有报告称减量患者的疼痛加剧。我们旨在评估阿片类药物剂量减量与随后与疼痛相关的医疗保健利用（急诊科就诊、住院和初级保健就诊）之间的关联。
设计、设置和研究对象：我们使用Optum Labs数据仓库的数据进行了一项回顾性队列研究，该仓库包含美国商业保险和医疗保险优势参保者的去识别化回顾性行政索赔数据。在12个月的基线期内，年龄≥18岁且被开具稳定剂量阿片类药物（≥50毫克吗啡当量[MME]/天）的成年人。
方法
减量定义为在6个重叠的60天时间段中的某一个时间段内，平均每日阿片类药物剂量相对减少≥15%。减量的患者时间段被细分为减量并继续使用（MME＞0）与减量并停药（MME = 0）。我们使用负二项回归模型，将队列进入后长达12个月的疼痛诊断就诊月度计数作为减量、基线利用率和患者水平协变量的函数进行建模。
结果
在47033名患者中，13793名患者进行了减量。与未减量相比，任何减量都与更多因疼痛而进行的急诊科就诊相关（调整发病率比[aIRR]为1.21，95%置信区间[CI]：1.11 - 1.30），减量后继续使用状态与更多因疼痛而进行的急诊科就诊（aIRR为1.23，CI：1.14 - 1.32）和住院相关（aIRR为1.14，CI：1.03 - 1.27），而减量并停药与因疼痛而进行的初级保健就诊较少相关（aIRR为0.68，CI：0.61 - 0.76）。
结论
这些关联表明，阿片类药物减量可能导致急性疼痛的急诊和住院利用率增加，对于那些停用阿片类药物的患者，可能会降低对初级保健的感知需求。
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