Comparative effectiveness of pain control between opioids and gabapentinoids in older patients with chronic pain.
Comparative effectiveness of pain control between opioids and gabapentinoids in older patients with chronic pain.
复制标题
阿片类药物和加巴喷丁类药物对老年慢性疼痛患者的疼痛控制效果比较。
DOI：
10.1097/j.pain.0000000000003006
复制
发表时间：
2024
期刊：
影响因子：
7.4
通讯作者：
Kuo,Yong-Fang
中科院分区：
文献类型：
--
作者：
Kim,Emily;Raji,MukailaA;Westra,Jordan;Wilkes,Denise;Kuo,Yong-Fang
Gabapentinoid (GABA) prescribing has substantially increased while opioid prescribing has decreased since the 2016 Centers for Disease Control and Prevention Guidelines restricted opioid prescribing for chronic pain. The shift to GABA assumes equal analgesic effectiveness to opioids, but no comparative analgesic effectiveness data exist to support this assumption. We compared GABA to opioids by assessing changes in pain interfering with activities (activity-limiting pain) over time in patients with chronic pain. We used 2017 to 2019 data from a 20% national sample of Medicare beneficiaries diagnosed with chronic pain who initiated a GABA or opioid prescription for $30 continuous days and received home health care in the study year. The main outcome was the difference in reduction in pain score from pre-to post-prescription assessments between the 2 groups. Within a 60-day window before-and-after drug initiation, our sample comprised 3208 GABA users and 2846 opioid users. Reduction in post-prescription scores of painrelated interference with activities to less-than-daily pain was 48.1% in the GABA group and 41.7% in the opioid group; this remained significant (odds ratio 5 1.29, 95% confidence interval: 1.17-1.43, P, 0.0001) after adjustment for patient demographics and comorbidities. The adjusted difference in reduced pain-related interference score between the 2 groups was 20.10 points on a 0 to 4 scale (P 5 0.01). Gabapentinoid use had greater odds of less-than-daily pain post-prescription, in a dose-dependent manner. Thus, GABA use was associated with a larger reduction in chronic pain than opioids, with a larger effect at higher GABA dosage. Future research is needed on functional outcomes in patients with chronic pain prescribed GABA or opioids.
