Pain as a Predictor of Opioid Use Disorder in a Nationally Representative Sample
Pain as a Predictor of Opioid Use Disorder in a Nationally Representative Sample
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DOI：
10.1176/appi.ajp.2016.15091179
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发表时间：
2016-12-01
影响因子：
17.7
通讯作者：
Olfson, Mark
中科院分区：
文献类型：
--
作者：
Blanco, Carlos;Wall, Melanie M.;Olfson, Mark
目的：作者试图确定美国非机构化人群中度和重度疼痛与处方阿片类药物使用障碍之间的关系。方法：使用结构方程模型前瞻性评估酒精及相关病症国家流行病学调查第 1 波（2001-2002 年）和第 2 波（2004-2005 年）疼痛与处方阿片类药物使用障碍之间的相互依赖性。疼痛采用日常活动中与疼痛相关的干扰的 5 级量表进行测量，并分为“无疼痛”（无或很少干扰）或“疼痛”（中度至极度干扰）。通过结构化访谈（酒精使用障碍和相关残疾访谈时间表 - DSM-IV 版本）评估处方阿片类药物使用障碍。其他协变量包括年龄、性别、焦虑或情绪障碍，以及吸毒、酗酒和行为问题的家族史。结果：在结构方程模型中，疼痛和处方阿片类药物使用障碍在基线和 3 年随访中彼此显着相关。然而，虽然基线时的疼痛也与随访时的处方阿片类药物使用障碍显着相关，但基线时的处方阿片类药物使用障碍与随访时的疼痛无关。这些关联独立于一些背景人口统计和临床特征。疼痛干扰路径与处方阿片类药物使用障碍的风险相对增加 41% 相关。结论：疼痛状况会增加处方阿片类药物使用障碍的风险。为了帮助减少患有中度至重度疼痛的成年人处方阿片类药物滥用和依赖的发生率，有必要仔细监测和考虑非阿片类替代疗法。
Objective: The authors sought to ascertain the relationship between moderate and more severe pain and prescription opioid use disorders in the noninstitutionalized U.S. population.Method: A structural equation model was used to assess prospectively the interdependency of pain and prescription opioid use disorder at waves 1(2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Pain was measured with a 5-point scale of pain-related interference in daily activities and dichotomized as "no pain" (no or little interference) or "pain" (moderate to extreme interference). Prescription opioid use disorder was assessed with a structured interview (the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version). Other covariates included age, sex, anxiety or mood disorders, and family history of drug, alcohol, and behavioral problems.Results: In the structural equation model, pain and prescription opioid use disorders were significantly associated with one another at baseline and at 3-year follow-up. However, whereas pain at baseline was also significantly associated with prescription opioid use disorder at follow-up, prescription opioid use disorder at baseline was not associated with pain at follow-up. These associations were independent of several background demographic and clinical characteristics. The path for pain interference was associated with a 41% relative increase in the risk of developing a prescription opioid use disorder.Conclusions: Painful conditions contribute to the risk of prescription opioid use disorders. To help reduce the incidence of prescription opioid abuse and dependence among adults with moderate to severe pain, careful monitoring and consideration of nonopioid alternative treatments is warranted.