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入院时使用阿片类药物会增加对医院内专业疼痛服务的需求:来自挪威四家大学医院基于登记处研究的证据。

Opioid use at admittance increases need for intrahospital specialized pain service: Evidence from a registry-based study in four Norwegian university hospitals.

作者信息

Nordrik Torbjørn, Rotevatn Elisabeth Ørskov, Mannseth Janne, Stubhaug Audun, Rygh Lars Jørgen

机构信息

Department of Clinical Science, Faculty of Medicine, University of Bergen, Postboks 7804, 5020, Bergen, Norway.

Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Postboks 1400, 5021, Bergen, Norway.

出版信息

Scand J Pain. 2025 Jun 20;25(1). doi: 10.1515/sjpain-2025-0008. eCollection 2025 Jan 1.

Abstract

OBJECTIVES

Acute Pain Services (APS) have significantly evolved since their establishment in the 1990s, emphasizing multimodal analgesia, which is a pivotal component of enhanced recovery after surgery, to enhance postoperative recovery. Despite improvements, variability in pain trajectories among patients necessitated the development of transitional pain units to address individual needs and ensure safe opioid tapering. The Norwegian National Registry for Advanced Acute Pain Services (AAPS), known as SmerteReg, was established to further enhance understanding of pain treatment in these patients. In this study, we aimed to analyze opioid use patterns and characteristics of opioid users referred to AAPS compared to non-opioid users.

METHODS

Data from SmerteReg (2016-2020) were analyzed, including patient demographics, diagnoses, pain treatment, and patient-reported outcome measures. Patient characteristics at admittance were compared between opioid users and non-opioid users. Multivariate logistic regression was used to explore factors associated with opioid use.

RESULTS

Of 1,068 patient tracks, 64% were opioid users at admittance. Opioid users were older and more frequently female, reporting higher levels of anxiety, depression, catastrophizing, and sleep problems before admission. Sleep problems before admittance was reported three times more frequent by patients using opioids compared to patients not using an opioid at admittance.

CONCLUSION

Pre-admittance opioid use was prevalent among patients referred to AAPS, emphasizing the need for tailored pain management strategies. Women, older patients, and those reporting sleep problems before admittance were more likely to use opioids. The finding that sleep problems before admittance were strongly associated with opioid use, suggests the importance of addressing sleep disturbances in pain management protocols. This study contributes to understanding opioid use patterns and factors influencing pain management in hospitalized patients.

摘要

目的

自20世纪90年代成立以来,急性疼痛服务(APS)有了显著发展,强调多模式镇痛,这是术后加速康复的关键组成部分,以促进术后恢复。尽管有所改善,但患者疼痛轨迹的变异性使得有必要设立过渡性疼痛单元,以满足个体需求并确保安全减少阿片类药物用量。挪威高级急性疼痛服务国家登记处(AAPS),即疼痛登记处(SmerteReg),旨在进一步增进对这些患者疼痛治疗的了解。在本研究中,我们旨在分析转诊至AAPS的阿片类药物使用者与非阿片类药物使用者的阿片类药物使用模式及特征。

方法

分析了疼痛登记处(SmerteReg,2016 - 2020年)的数据,包括患者人口统计学信息、诊断、疼痛治疗以及患者报告的结局指标。比较了阿片类药物使用者和非阿片类药物使用者入院时的患者特征。采用多因素逻辑回归分析与阿片类药物使用相关的因素。

结果

在1068条患者记录中,64%的患者入院时为阿片类药物使用者。阿片类药物使用者年龄更大,女性更为常见,入院前报告的焦虑、抑郁、灾难化思维及睡眠问题水平更高。与入院时未使用阿片类药物的患者相比,使用阿片类药物的患者入院前睡眠问题的报告频率高出两倍。

结论

转诊至AAPS的患者中,入院前使用阿片类药物的情况普遍,这凸显了制定个性化疼痛管理策略的必要性。女性、老年患者以及入院前报告有睡眠问题的患者更有可能使用阿片类药物。入院前睡眠问题与阿片类药物使用密切相关这一发现,表明在疼痛管理方案中解决睡眠障碍的重要性。本研究有助于了解住院患者的阿片类药物使用模式及影响疼痛管理的因素。

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