Benzodiazepine use in patients with chronic pain in an interdisciplinary pain rehabilitation program.
Benzodiazepine use in patients with chronic pain in an interdisciplinary pain rehabilitation program.
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DOI：
10.2147/jpr.s123487
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发表时间：
2017
影响因子：
2.7
通讯作者：
Hooten WM
中科院分区：
文献类型：
--
作者：
Cunningham JL;Craner JR;Evans MM;Hooten WM
在阿片类药物广泛使用的背景下，人们越来越重视苯二氮类药物和阿片类药物同时使用的潜在有害影响。虽然阿片类药物在慢性疼痛中的使用一直是一个主要焦点，但BZD的使用也同样令人担忧。因此，这项研究的主要目的是确定BZD与成人慢性疼痛患者在接受门诊跨学科疼痛康复(IPR)计划时使用阿片类药物之间的关系。这项研究队列涉及从2013年1月到2014年12月连续847名患者参加了为期3周的门诊知识产权计划。研究变量包括基线人口学和临床特征、流行病学研究中心-抑郁量表、疼痛灾变量表和多维疼痛问卷的疼痛严重程度子量表。入院时，248名患者(29%)正在服用BZDS。使用BZD的患者明显更有可能使用阿片类药物，而且是女性。此外，使用BZD的患者有明显更严重的抑郁、疼痛灾难性和疼痛严重程度评分。在单变量Logistic回归分析中，阿片类药物的使用、女性以及抑郁、疼痛灾难性和疼痛严重程度的较高得分与BZD的使用显著相关。在调整了年龄、性别、疼痛持续时间、阿片类药物使用、抑郁、疼痛灾变和疼痛严重程度的多变量Logistic回归分析中，只有女性和更严重的抑郁评分与BZD的使用显著相关。在参加门诊IPR计划的患者中，女性和更严重的抑郁评分与BZD的使用有关。结果发现BZD在慢性疼痛患者中的使用率很高，并强调了在这一患者群体中使用BZD时权衡风险和好处的必要性。
In the context of widespread opioid use, increased emphasis has been placed on the potentially deleterious effects of concurrent benzodiazepine (BZD) and opioid use. Although use of opioids in chronic pain has been a major focus, BZD use is equally concerning. Thus, the primary aim of this study was to determine the associations between BZD and opioid use in adults with chronic pain upon admission to an outpatient interdisciplinary pain rehabilitation (IPR) program. The study cohort involved 847 consecutive patients admitted to a 3-week outpatient IPR program from January 2013 through December 2014. Study variables included baseline demographic and clinical characteristics, Center for Epidemiologic Studies-Depression Scale, Pain Catastrophizing Scale, and the pain severity subscale of the Multidimensional Pain Inventory. Upon admission, 248 (29%) patients were taking BZDs. Patients using BZDs were significantly more likely to use opioids and to be female. Additionally, patients using BZDs had significantly greater depression, pain catastrophizing, and pain severity scores. In univariable logistic regression analysis, opioid use, female sex, and greater scores of depression, pain catastrophizing, and pain severity were significantly associated with BZD use. In multivariable logistic regression analysis adjusted for age, sex, pain duration, opioid use, depression, pain catastrophizing, and pain severity, only female sex and greater depression scores were significantly associated with BZD use. Among patients participating in an outpatient IPR program, female sex and greater depression scores were associated with BZD use. Results identify a high prevalence of BZD use in patients with chronic pain and reinforce the need to weigh the risks versus benefits when prescribing in this patient population.