Withdrawal symptoms predict prescription opioid dependence in chronic pain patients
Withdrawal symptoms predict prescription opioid dependence in chronic pain patients
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DOI：
10.1016/j.drugalcdep.2018.11.013
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发表时间：
2019-02-01
影响因子：
4.2
通讯作者：
Perez-Carbonell, Ana
中科院分区：
文献类型：
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作者：
Coloma-Carmona, Ainhoa;Carballo, Jose L.;Perez-Carbonell, Ana
背景：精神障碍诊断与统计手册（DSM-5）的最新版本包括处方阿片类药物使用障碍（POUD）的实质性变化。在将其作为标准移除后，本研究的目的是估计处方阿片类药物长期使用者戒断症状的患病率及其与新的DSM-5 POUD分类的关系。方法：收集215名长期服用阿片类药物的慢性非癌性疼痛患者的数据。参与者完成了社会人口学、戒断形容词评定量表（ARSW）、阿片类药物治疗特征、POUD标准（DSM-5）和疼痛强度测量。结果：26.6%的参与者被分类为中度至重度POUD。中度/重度POUD患者，年龄较小，疼痛强度较高，戒断症状强度较高（p < 0.01）。重度戒断患者抗焦虑药物（p < 0.01）、抗抑郁药物（p < 0.05）使用及吸烟者比例（p < 0.05）均显著高于重度戒断患者。Logistic回归分析提示中度[比值比(OR) = 3.25]和重度（OR = 10.52）戒断是POUD的最强预测因子。年龄、抗焦虑药的使用和吸烟也与POUD相关，但多水平分析显示，这些变量并不能调节戒断强度与POUD之间的关系。结论：阿片类药物治疗过程中戒断强度的升高可用于识别POUD患者。需要进一步的研究来评估这些发现在长期阿片类药物治疗慢性疼痛中的临床意义。
Background: The last version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes substantial changes for prescription opioid-use disorder (POUD). After its removal as a criterion, the goal of this study was to estimate the prevalence of withdrawal symptoms in long-term users of prescription opioids and its association with the new DSM-5 POUD classification.Methods: Data were collected from 215 long-term consumers of opioid medication who were chronic non-cancer pain patients. Participants completed sociodemographic, Adjective Rating Scale for Withdrawal (ARSW), opioid treatment characteristics, POUD criteria (DSM-5), and pain intensity measurements.Results: 26.6% of the participants were classified with moderate to severe POUD. Higher intensity of withdrawal symptoms was found in patients with moderate/severe POUD, younger age, and higher pain intensity (p < .01). Anxiolytics (p < .01) and antidepressants use (p < .05) and percentage of smokers (p < .05) were significantly higher in patients with severe withdrawal. Logistic regression analyses suggested moderate [odds ratio (OR) = 3.25] and severe (OR = 10.52) withdrawal as the strongest predictor of POUD. Age, anxiolytics use, and smoking were also associated with POUD, but multilevel analysis showed that these variables do not moderate the association between withdrawal intensity and POUD.Conclusion: Escalation of withdrawal intensity during opioid treatment can be used to identify patients with POUD. Further studies are needed to assess the clinical implications of these findings during long-term opioid therapy for chronic pain.