Burrus Cyrille, Duong Hong Phuoc, Vuistiner Philippe, Konzelmann Michel, Léger Bertrand, Luthi François
Departments of Medical Research Suva Clinics and.
Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland.
Pain Rep. 2025 Aug 12;10(5):e1321. doi: 10.1097/PR9.0000000000001321. eCollection 2025 Oct.
Opioid prescription is associated with various biopsychosocial (BPS) domains. Explaining how they interact is worth to better understand their role.
To assess direct and indirect effects of BPS complexity and pain-related factors on opioid prescription in patients with chronic musculoskeletal pain.
We included 3,923 individuals admitted to a tertiary care rehabilitation clinic. Two outcomes were defined: likelihood of opioid prescription at admission (yes/no) and daily morphine equivalent dose (dMED) during rehabilitation. Predictors were sociodemographic factors, injury severity and location, pain-related factors (pain catastrophizing, depressive symptoms, pain severity), and BPS complexity assessed by the INTERMED method. Structural equation modelling was used to assess the direct and indirect effects of BPS complexity on outcomes.
Biopsychosocial complexity had a direct effect on opioid prescription (OR 1.20; 95% CI 1.10-1.32) and indirect effects via pain severity (OR 1.09; 95% CI 1.06-1.12) and depressive symptoms (OR 1.02; 95% CI 1.00-1.04). Biopsychosocial complexity also had direct effect on dMED (β = 1.17, 95% CI 1.06-1.28) and an indirect effect via pain severity (exp β = 1.03; 95% CI 1.00-1.07). Pain catastrophizing was indirectly associated with opioid prescription and dose via pain. The likelihood of opioid prescription was associated with female sex, increased education level, and spine trauma; the latter 2 factors were also associated with increased dMED.
Our study suggests that BPS complexity is associated with opioid prescription and dose, with direct and indirect effects via pain severity or depressive symptoms. Screening and addressing patients' complexity may help decrease opioid prescriptions and risk of misuse.
阿片类药物处方与各种生物心理社会（BPS）领域相关。解释它们如何相互作用有助于更好地理解其作用。
评估BPS复杂性和疼痛相关因素对慢性肌肉骨骼疼痛患者阿片类药物处方的直接和间接影响。
我们纳入了3923名入住三级护理康复诊所的患者。定义了两个结局：入院时开具阿片类药物处方的可能性（是/否）以及康复期间的每日吗啡当量剂量（dMED）。预测因素包括社会人口统计学因素、损伤严重程度和部位、疼痛相关因素（疼痛灾难化、抑郁症状、疼痛严重程度）以及通过INTERMED方法评估的BPS复杂性。采用结构方程模型评估BPS复杂性对结局的直接和间接影响。
生物心理社会复杂性对阿片类药物处方有直接影响（比值比1.20；95%置信区间1.10 - 1.32），并通过疼痛严重程度（比值比1.09；95%置信区间1.06 - 1.12）和抑郁症状（比值比1.02；95%置信区间1.00 - 1.04）产生间接影响。生物心理社会复杂性对dMED也有直接影响（β = 1.17，95%置信区间1.06 - 1.28），并通过疼痛严重程度产生间接影响（指数β = 1.03；95%置信区间1.00 - 1.07）。疼痛灾难化通过疼痛与阿片类药物处方和剂量间接相关。阿片类药物处方的可能性与女性、教育水平提高和脊柱创伤有关；后两个因素也与dMED增加有关。
我们的研究表明，BPS复杂性与阿片类药物处方和剂量相关，通过疼痛严重程度或抑郁症状产生直接和间接影响。筛查并处理患者的复杂性可能有助于减少阿片类药物处方和滥用风险。
