Chronic non-cancer pain among adults with substance use disorders: Prevalence, characteristics, and association with opioid overdose and healthcare utilization
Chronic non-cancer pain among adults with substance use disorders: Prevalence, characteristics, and association with opioid overdose and healthcare utilization
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DOI：
10.1016/j.drugalcdep.2020.107902
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发表时间：
2020-04-01
影响因子：
4.2
通讯作者：
Wu, Li-Tzy
中科院分区：
文献类型：
--
作者：
John, William S.;Wu, Li-Tzy
背景：物质使用障碍（SUD）患者中的慢性非癌性疼痛（CNCP）有导致治疗结果恶化的风险。了解CNCP与SUD的关联对于了解SUDs患者疼痛评估/管理的需求和潜在益处非常重要。方法：我们分析了2013年至2018年大型学术医疗保健系统中年龄≥ 18岁（N = 951，533;平均年龄：48.4岁; 57.4%女性）成人的电子健康记录数据。调整后的logistic回归模型进行估计与阿片类药物过量，急诊室利用率，并按不同的SUD诊断和性别分层住院CNCP条件的关联：在总样本中，CNCP的患病率为46.6%，任何SUD为11.2%。大多数SUD患者患有CNCP（阿片类药物：74.7%;镇静剂：72.3%;大麻：64.3%;酒精：58.7%;烟草：59.5%）。对于大多数SUD诊断，女性CNCP的患病率高于男性。在每个SUD组中，CNCP的存在与更多的心理健康障碍和慢性疾病相关。CNCP与阿片类药物使用障碍患者中过量用药的几率显著降低相关，但与其他SUD中过量用药和医疗保健利用的几率增加相关。CNCP与过量的女性，但不是男性，酒精或非阿片类药物使用disorders.Conclusions：CNCP和负面的健康指标之间的关联的方向和幅度不同的SUD类型和性别的函数，分别。提高对潜在未满足疼痛治疗需求的认识可能对改善SUD结局有影响。
Background: Chronic non-cancer pain (CNCP) among patients with substance use disorder (SUD) poses a risk for worse treatment outcomes. Understanding the association of CNCP with SUD is important for informing the need and potential benefits of pain assessment/management among those with SUDs.Methods: We analyzed electronic health record data from 2013 to 2018 among adults aged >= 18 years (N = 951,533; mean age: 48.4 years; 57.4 % female) in a large academic healthcare system. Adjusted logistic regression models were conducted to estimate the association of CNCP conditions with opioid overdose, emergency department utilization, and inpatient hospitalization stratified by different SUD diagnoses and by gender.Results: Among the total sample, the prevalence of CNCP was 46.6 % and any SUD was 11.2 %. The majority of patients with a SUD had CNCP (opioid: 74.7 %; sedative: 72.3 %; cannabis: 64.3 %; alcohol: 58.7 %; tobacco: 59.5 %). The prevalence of CNCP was greater in females vs. males for most SUD diagnoses. The presence of CNCP was associated with more mental health disorders and chronic medical conditions among each SUD group. CNCP was associated with significantly decreased odds of overdose among those with opioid use disorder but increased odds of overdose and healthcare utilization among other SUDs. CNCP was positively associated with overdose in females, but not males, with alcohol or non-opioid drug use disorders.Conclusions: The direction and magnitude of the association between CNCP and negative health indicators differed as a function of SUD type and gender, respectively. Greater awareness of potential unmet pain treatment need may have implications for improving SUD outcomes.