Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000
Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000
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DOI：
10.1016/j.pain.2004.03.006
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发表时间：
2004-06-01
期刊：
影响因子：
7.4
通讯作者：
Woloshin, S
中科院分区：
文献类型：
--
作者：
Caudill-Slosberg, MA;Schwartz, LM;Woloshin, S
在过去十年中，在国家指南、“疼痛是第五大生命体征”运动和直接面向消费者的广告的推动下，疼痛的治疗受到了越来越多的关注。我们对1980年和2000年的数据进行了比较，研究了全国办公室就诊和肌肉骨骼疼痛镇痛治疗的趋势。我们分析了全国门诊医疗调查（NAMCS）——一项对以办公室为基础的医生就诊的全国代表性调查——使用1980-81年（n = 89000次）和1999-2000年（n = 45000次）的数据。在此期间，急性（19比33%，RR = 1.74; 95% CI, 1.52-1.95）和慢性（25比29%，RR = 1.16; 95% CI, 0.97-1.35）肌肉骨骼疼痛就诊的非甾体抗炎药处方均有所增加。2000年，三分之一的非甾体抗炎药处方是用于COX - 11。急性疼痛的阿片类药物增加（8比11%，RR = 1.38; 95% CI, 0.92-1.83），慢性疼痛的阿片类药物增加一倍（8比16%，RR = 2.0; 95% CI, 1.52-2.48）。使用更有效的阿片类药物（氢可酮、羟考酮、吗啡）治疗慢性肌肉骨骼疼痛的比例从2%增加到9% （RR = 4.5; 95% CI, 2.18-6.87）。这相当于2000年服用强效阿片类药物的590万人次，比1980年增加了460万人次（假设门诊总人次保持在2000年水平不变）。尽管人们越来越关注疼痛治疗，但因肌肉骨骼疼痛而就诊的人数并没有增加。然而，处方非甾体抗炎药和阿片类药物的门槛已经下降。(C) 2004国际疼痛研究协会。Elsevier B.V.版权所有。
The treatment of pain has received increasing attention over the past decade promoted by national guidelines, the 'pain as the 5th vital sign' campaign and direct-to-consumer advertising. We examined national trends in office visits and analgesic treatment for musculoskeletal pain in the office setting, comparing data from 1980 and 2000. We analysed the National Ambulatory Medical Care Survey (NAMCS)-a nationally representative survey of visits to office-based physicians - using data from 1980-81 (n = 89 000 visits) and 1999-2000 (n = 45 000 visits). During this time, NSAID prescriptions increased for both acute (19 vs. 33%, RR = 1.74; 95% CI, 1.52-1.95) and chronic (25 vs. 29%, RR = 1.16; 95% CI, 0.97-1.35) musculoskeletal pain visits. In 2000, one-third of the NSAID prescriptions were for COX 11 agents. Opioids increased for acute pain (8 vs. 11%, RR = 1.38; 95% CI, 0.92-1.83) and doubled for chronic pain (8 vs. 16%, RR = 2.0; 95% CI, 1.52-2.48). The use of more potent opioids (hydrocodone, oxycodone, morphine) for chronic musculoskeletal pain increased from 2 to 9% of visits (RR = 4.5; 95% CI, 2.18-6.87). This corresponds to 5.9 million visits where potent opioids were prescribed in 2000-an increase of 4.6 million visits from 1980 (assuming the total number of outpatient visits was constant at the 2000 level). In spite of the increased attention to pain treatment, there has not been an increase in office visits for musculoskeletal pain complaints. The threshold for prescribing NSAIDS and opioids, however, has dropped. (C) 2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.