Ren Xinyi, Xia Ting, Mathieson Stephanie, Abdel Shaheed Christina, Nielsen Suzanne, Collie Alex, Di Donato Michael F
Monash Addiction Research Centre, Eastern Clinical School, Monash University, Melbourne, VIC 3199, Australia.
Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW 3150, Australia.
Pain Med. 2025 Jul 1;26(7):362-371. doi: 10.1093/pm/pnaf017.
To identify longitudinal patterns in opioid dispensing dosages for workers with low back pain within a workers' compensation setting and to explore the risk factors associated with high-dose and persistent opioid use.
We included workers with accepted claims for low back pain received by insurers between January 1, 2010, and June 30, 2016, with a follow-up period of 3.5 years (data censoring on December 31, 2020) across Victoria. Trajectory modeling was used to identify different opioid dispensing patterns. Logistic regressions were utilized to compare the workers' characteristics across different opioid dispensing pattern groups.
Among 14 703 accepted claims, 33.1% reported receiving opioid medications as part of their claims. Six opioid dispensing patterns were identified. Individuals in the highest socioeconomic status (SES) quintile were less likely to rapidly escalate to dispensing high-dose opioids (odds ratio [OR]: 0.58, 99% CI 0.34, 0.99) compared to other quintiles. Workers dispensed gabapentinoids and antidepressants showed an increased risk of long-term high-dose opioid use (OR: 7.96, 99% CI 5.42, 11.69; OR: 21.75, 99% CI 14.30, 33.08) relative to workers with a single opioid dispensing. Those who had surgery were also more likely to use long-term high-dose opioids compared to a non-surgery group.
Lower SES, having gabapentinoids or antidepressants prescriptions or having had surgery are all associated with persistent opioid use among workers with LBP. These demographic and clinical risk factors for developing persistent opioid use could help identify individuals who would benefit from early intervention, reducing the likelihood of opioid dependence for pain management and minimizing the risk of harm.
确定工人赔偿环境下腰痛患者阿片类药物配药剂量的纵向模式，并探讨与高剂量和持续使用阿片类药物相关的风险因素。
我们纳入了2010年1月1日至2016年6月30日期间保险公司受理的腰痛索赔工人，在维多利亚州进行了3.5年的随访（数据截止于2020年12月31日）。轨迹模型用于识别不同的阿片类药物配药模式。逻辑回归用于比较不同阿片类药物配药模式组的工人特征。
在14703例受理的索赔中，33.1%报告称在索赔中接受了阿片类药物治疗。确定了六种阿片类药物配药模式。与其他五分位数相比，社会经济地位（SES）最高五分位数的个体迅速升级为高剂量阿片类药物配药的可能性较小（优势比[OR]：0.58，99%可信区间0.34，0.99）。与单一阿片类药物配药的工人相比，配用加巴喷丁类药物和抗抑郁药的工人长期高剂量使用阿片类药物的风险增加（OR：7.96，99%可信区间5.42，11.69；OR：21.75，99%可信区间14.30，33.08）。与非手术组相比，接受手术的工人也更有可能长期高剂量使用阿片类药物。
较低的社会经济地位、开具加巴喷丁类药物或抗抑郁药处方或接受过手术均与腰痛工人持续使用阿片类药物有关。这些导致持续使用阿片类药物的人口统计学和临床风险因素有助于识别可能从早期干预中受益的个体，降低疼痛管理中阿片类药物依赖的可能性，并将危害风险降至最低。
