The effects of depression and smoking on pain severity and opioid use in patients with chronic pain
The effects of depression and smoking on pain severity and opioid use in patients with chronic pain
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DOI：
10.1016/j.pain.2010.10.045
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发表时间：
2011-01-01
期刊：
影响因子：
7.4
通讯作者：
Warner, David O.
中科院分区：
文献类型：
--
作者：
Hooten, W. Michael;Shi, Yu;Warner, David O.
抑郁症和吸烟是患有慢性疼痛的成年人中常见的并存疾病。本研究的目的是根据吸烟状况确定抑郁症对慢性疼痛患者的临床疼痛和阿片类药物使用的独立影响。从2003年9月到2007年2月，在一系列连续接受为期3周的门诊疼痛治疗计划的患者中，采用回溯性设计来评估抑郁的基线水平、临床疼痛、阿片类药物剂量(按吗啡当量计算)和吸烟状况。使用流行病学研究中心抑郁量表评估抑郁，并使用多维疼痛清单的疼痛严重程度子量表评估临床疼痛。研究队列(n=1241)包括313名现在吸烟者、294名既往吸烟者和634名从不吸烟者。与既往吸烟者和从不吸烟者相比，现在吸烟者的基线抑郁(P=.001)和临床疼痛(P=.001)更严重，吸烟者与从不吸烟者相比，每日吗啡当量剂量更大(P=.005)。在多变量线性回归分析中，基线疼痛严重程度与更严重的抑郁程度独立相关，但与吸烟状况无关。然而，目前吸烟者的状况与更多的阿片类药物使用(27毫克/天)独立相关，与抑郁评分无关。抑郁症、吸烟状态、阿片类药物使用和慢性疼痛之间的关系是复杂的，抑郁症和吸烟状态都可能是治疗使用阿片类药物的慢性疼痛患者的重要考虑因素。这项研究发现，疼痛的严重程度与更严重的抑郁有关，但与吸烟无关；然而，吸烟与更多的阿片类药物使用有关，与抑郁无关。(C)2010年国际疼痛研究协会。爱思唯尔出版公司版权所有。
Depression and smoking are common comorbid conditions among adults with chronic pain. The aim of this study was to determine the independent effects of depression on clinical pain and opioid use among patients with chronic pain according to smoking status. A retrospective design was used to assess baseline levels of depression, clinical pain, opioid dose (calculated as morphine equivalents), and smoking status in a consecutive series of patients admitted to a 3-week outpatient pain treatment program from September 2003 through February 2007. Depression was assessed using the Centers for Epidemiologic Studies-Depression scale, and clinical pain was assessed using the pain severity subscale of the Multidimensional Pain Inventory. The study cohort (n = 1241) included 313 current smokers, 294 former smokers, and 634 never smokers. Baseline depression (P = .001) and clinical pain (P = .001) were greater among current smokers compared to former and never smokers, and the daily morphine equivalent dose was greater among smokers compared to never smokers (P = .005). In multivariate linear regression analyses, baseline pain severity was independently associated with greater levels of depression, but not with smoking status. However, status as a current smoker was independently associated with greater opioid use (by 27 mg/d), independent of depression scores. The relationship between depression, smoking status, opioid use, and chronic pain is complex, and both depression and smoking status may be potentially important considerations in the treatment of patients with chronic pain who utilize opioids. This study found that pain severity was associated with greater depression but not smoking; however, smoking was associated with greater opioid use, independent of depression. (C) 2010 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.