de Kleijn Loes, Struik Laura, Rijkels-Otters Hanneke J B M, Chiarotto Alessandro, Koes Bart W, van den Driest Jacoline J
Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Research Unit of General Practice, Department of Public Health and Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.
Eur J Pain. 2025 Jul;29(6):e70061. doi: 10.1002/ejp.70061.
Pain guidelines recommend de-prescribing long-term opioid treatment (LTOT) in non-cancer pain for reasons of risk-benefit balance. However, the prevalence and changes over time with regard to LTOT in patients with chronic non-cancer pain in Dutch primary care are unknown. Hence, we examined the prevalence and characteristics and investigated associated diagnoses, comorbidities, co-medications and changes in prescription numbers between 2013 and 2022.
This retrospective population-based cohort study was conducted using the Rijnmond Primary Care Database, which includes over 500,000 patient records from at least 240 GPs within the greater region of Rotterdam. All episodes of LTOT (> 3 months) in patients > 18 years from 2013 to 2022 were included. Descriptive statistics were adopted to characterise the study cohort. The prevalence of LTOT from 2013 to 2022 was calculated per 100 patient years.
Musculoskeletal complaints were the main registered indication by the first prescription of opioids. Patients were more frequently female (66.9%), with a mean age of 62.6 years. Most common comorbidities included diabetes mellitus and depressive disorder. The prevalence of LTOT increased twofold from 0.54% (95% CI: 0.51-0.58) per 100 patient years in 2013 to 1.04% (95% CI: 1.00-1.07) in 2022. The proportion of LTOT episodes solely involving potent opioids slightly increased between 2013 and 2022.
This study demonstrated a twofold increase in the prevalence of LTOT for chronic non-cancer pain in Dutch primary care from 2013 to 2022. Musculoskeletal pain complaints were the main indication. From 2013 to 2022 potent opioids assumed a more prominent role in LTOT.
The about twofold increase in long-term opioid therapy for chronic non-cancer pain between 2013 and 2022, along with the specific rise in potent opioid prescriptions in Dutch primary care, highlights an urgent need for future studies. These studies should focus on developing strategies to accelerate the implementation of revised primary care pain guidelines, especially given the limited effectiveness of long-term opioid treatment in non-cancer pain and the anticipated rise in chronic non-cancer pain due to Europe's ageing population.
鉴于风险效益平衡，疼痛指南建议在非癌性疼痛中停用长期阿片类药物治疗（LTOT）。然而，荷兰初级保健中慢性非癌性疼痛患者LTOT的患病率及其随时间的变化尚不清楚。因此，我们研究了2013年至2022年间LTOT的患病率、特征，并调查了相关诊断、合并症、联合用药情况以及处方数量的变化。
这项基于人群的回顾性队列研究使用了Rijnmond初级保健数据库，该数据库包含鹿特丹大区至少240名全科医生的50多万份患者记录。纳入了2013年至2022年18岁以上患者的所有LTOT发作（>3个月）。采用描述性统计来描述研究队列。计算2013年至2022年每100患者年的LTOT患病率。
肌肉骨骼疾病是阿片类药物首次处方的主要登记适应症。患者中女性更为常见（66.9%），平均年龄为62.6岁。最常见的合并症包括糖尿病和抑郁症。LTOT的患病率从2013年每100患者年的0.54%（95%CI：0.51 - 0.58）增加了两倍，至2022年的1.04%（95%CI：1.00 - 1.07）。2013年至2022年间，仅涉及强效阿片类药物的LTOT发作比例略有增加。
本研究表明，2013年至2022年荷兰初级保健中慢性非癌性疼痛的LTOT患病率增加了两倍。肌肉骨骼疼痛是主要适应症。2013年至2022年，强效阿片类药物在LTOT中发挥了更突出的作用。
2013年至2022年间，慢性非癌性疼痛的长期阿片类药物治疗增加了约两倍，以及荷兰初级保健中强效阿片类药物处方的特定增加，凸显了未来研究的迫切需求。这些研究应侧重于制定策略，以加速修订后的初级保健疼痛指南的实施，特别是考虑到长期阿片类药物治疗在非癌性疼痛中的有效性有限，以及由于欧洲人口老龄化导致慢性非癌性疼痛预计会增加。
