Opioid use behaviors, mental health and pain-Development of a typology of chronic pain patients
Opioid use behaviors, mental health and pain-Development of a typology of chronic pain patients
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DOI：
10.1016/j.drugalcdep.2009.03.021
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发表时间：
2009-09-01
影响因子：
4.2
通讯作者：
Calsyn, Donald A.
中科院分区：
文献类型：
--
作者：
Banta-Green, Caleb J.;Merrill, Joseph O.;Calsyn, Donald A.
背景：疼痛、成瘾和心理健康的交叉点尚未得到充分描述。我们描述了这三种情况在使用阿片类镇痛药的慢性疼痛患者人群中的作用。目的是为了提高我们对这一人群的理解，以及探讨如何识别不同类型的patients.Methods：我们进行了一项回顾性队列研究，在华盛顿州的一个大型综合组的医疗实践与长期使用阿片类药物的人（n=704）。使用代表DSM-IV阿片类药物滥用和依赖、阿片类药物滥用、疼痛、焦虑和抑郁的因素，通过潜在类别分析得出患者类别。回归分析探讨了自动化和访谈数据的实用性，以区分经验得出的患者groups.Results：三个类被确定：一个典型的组，绝大多数有持续的，中度的心理健康和疼痛症状;一个成瘾行为组与升高的心理健康症状和阿片类药物的问题，但疼痛类似的典型类;和疼痛功能障碍类，具有显著更高的疼痛干扰以及升高的心理健康和阿片类药物问题。处方的阿片类药物的平均每日剂量是那些在两个非典型组的三倍，并与调整后的其他variables.Conclusion类成员关系密切：我们描述了三种不同类型的病人类，以及数据元素，可以帮助确定两个非典型类型。需要进一步的研究来证实这些发现，并确定这种方法在其他临床环境中的实用性。(C)2009爱思唯尔爱尔兰有限公司保留所有权利。
Background: The intersection of pain, addiction and mental health has not been adequately described. We describe the roles of these three conditions in a chronic pain patient population using opioid analgesics. Aims were to improve our understanding of this population as well as to explore ways of identifying different types of patients.Methods: We conducted a retrospective cohort study in a large integrated group medical practice in Washington State with persons using opioids chronically (n=704). Patient classes were derived with latent class analysis using factors representing DSM-IV opioid abuse and dependence, opioid misuse, pain, anxiety and depression. Regression analyses explored the utility of automated and interview data to distinguish the empirically derived patient groups.Results: Three classes were identified: a Typical group, the substantial majority that had persistent, moderate mental health and pain symptoms; an Addictive Behaviors group with elevated mental health symptoms and opioid problems, but pain similar to the Typical class; and a Pain Dysfunction class with significantly higher pain interference as well as elevated mental health and opioid problems. Prescribed average daily dose of opioids was three times higher for those in the two atypical groups and was strongly associated with class membership after adjusting for other variables.Conclusion: We describe three distinct types of patient classes as well as data elements that could help identify the two atypical types. Further research is needed to confirm these findings and determine the utility of this approach in other clinical settings. (C) 2009 Elsevier Ireland Ltd. All rights reserved.