Is Smoking Associated with Alcohol-Drug Dependence in Patients with Pain and Chronic Pain Patients? An Evidence-Based Structured Review
Is Smoking Associated with Alcohol-Drug Dependence in Patients with Pain and Chronic Pain Patients? An Evidence-Based Structured Review
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DOI：
10.1111/j.1526-4637.2012.01446.x
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发表时间：
2012-09-01
期刊：
影响因子：
3.1
通讯作者：
Gao, Jinrun
中科院分区：
文献类型：
--
作者：
Fishbain, David A.;Cole, Brandly;Gao, Jinrun
目标。本研究的目的是确定是否有一致的证据表明，在疼痛和慢性疼痛患者（CPPs）的阿片类药物暴露期间，吸烟被认为是阿片类药物依赖发展的危险信号。方法。发现623篇参考文献涉及吸烟、疼痛和药物酒精依赖等领域。在应用排除标准后，仍有15项研究被分为四组，并针对四种假设进行了分类：吸烟的疼痛和CPPs患者比不吸烟的患者更有可能使用阿片类药物，需要更高的阿片类药物剂量，药物酒精依赖，并表现出异常服药行为（adtb）。根据卫生保健政策和研究局（AHCPR）的指导方针，每项研究都以其所代表的研究类型为特征，并由两名评分者根据13项质量标准进行独立评分，以产生质量分数。计算每组中支持/不支持每种假设的研究的百分比。每组证据的强度和一致性由AHCPR指南评定。结果。在每一组中，100%的研究都支持该组的假设。第一个假设的证据强度和一致性被评为A（一致的多个研究），另一个假设的证据强度和一致性被评为B（基本一致）。结论。有有限一致的间接证据表明，疼痛和CPPs患者的吸烟状况与酒精药物和阿片类药物依赖有关。吸烟状况可能是阿片类药物暴露导致阿片类药物依赖发展的危险信号。
Objective. The objective of this study was to determine if there is consistent evidence for smoking to be considered a red flag for development of opioid dependence during opioid exposure in patients with pain and chronic pain patients (CPPs). Methods. Six hundred and twenty-three references were found that addressed the areas of smoking, pain, and drug-alcohol dependence. Fifteen studies remained after exclusion criteria were applied and sorted into four groupings addressing four hypotheses: patients with pain and CPPs who smoke are more likely than their nonsmoking counterparts to use opioids, require higher opioid doses, be drug-alcohol dependent, and demonstrate aberrant drug-taking behaviors (ADTBs). Each study was characterized by the type of study it represented according to the Agency for Health Care Policy and Research (AHCPR) guidelines and independently rated by two raters according to 13 quality criteria to generate a quality score. The percentage of studies in each grouping supporting/not supporting each hypothesis was calculated. The strength and consistency of the evidence in each grouping was rated by the AHCPR guidelines. Results. In each grouping, 100% of the studies supported the hypothesis for that grouping. The strength and consistency of the evidence was rated as A (consistent multiple studies) for the first hypothesis and as B (generally consistent) for the other. Conclusions. There is limited consistent indirect evidence that smoking status in patients with pain and CPPs is associated with alcohol-drug and opioid dependence. Smoking status could be a red flag for opioid-dependence development on opioid exposure.