Early opioid prescription and subsequent disability among workers with back injuries
Early opioid prescription and subsequent disability among workers with back injuries
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DOI：
10.1097/brs.0b013e318160455c
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发表时间：
2008-01-15
期刊：
影响因子：
3
通讯作者：
Wickizer, Thomas M.
中科院分区：
文献类型：
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作者：
Franklin, Gary M.;Stover, Bert D.;Wickizer, Thomas M.
研究设计.前瞻性，基于人群的队列研究。研究腰背部损伤后6周内使用阿片类药物是否与1年后的工作能力丧失相关。背景资料摘要。与早期医疗有关的因素很少被调查为背部受伤工人长期工作残疾发展的可能危险因素。我们以前已经表明，约1/3的工人在腰痛后早期接受阿片类药物处方，最近的一项研究表明，这种处方可能会增加随后残疾的风险。我们分析了反映1843名工人在第一次医疗就诊后6周内因背部受伤而支付的阿片类药物账单的详细数据。其他基线测量包括来自医疗记录的损伤严重程度评级，以及来自在收到背部损伤索赔后18天（中位数）进行的工人调查的人口统计学、心理社会学、疼痛、功能、吸烟和酒精测量。索赔提交后1年的工作残疾的计算机数据库记录作为主要结局指标。近14%（1843人中的254人）的样本在1年内获得了工作伤残补偿。超过三分之一的工人（1843人中的630人）在6周内接受了阿片类药物处方，其中50.7%（630人中的319人）是在首次就诊时接受的。在调整疼痛、功能、损伤严重程度和其他基线协变量后，接受阿片类药物超过7天（比值比= 2.2; 95%可信区间，1.5-3.1）和接受1次以上阿片类药物处方与1年后的工作能力丧失显著相关。急性背部损伤工人服用阿片类药物超过7天是长期残疾的危险因素。需要进一步的研究来阐明这种关联。
Study Design. Prospective, population-based cohort study.Objective. To examine whether prescription of opioids within 6 weeks of low back injury is associated with work disability at 1 year.Summary of Background Data. Factors related to early medical treatment have been little investigated as possible risk factors for development of long-term work disability among workers with back injuries. We have previously shown that about 1 of 3 of workers receive an opioid prescription early after a low back injury, and a recent study suggested that such prescriptions may increase risk for subsequent disability.Methods. We analyzed detailed data reflecting paid bills for opioids prescribed within 6 weeks of the first medical visit for a back injury among 1843 workers with lost work-time claims. Additional baseline measures included an injury severity rating from medical records, and demographic, psychosocial, pain, function, smoking, and alcohol measures from a worker survey conducted 18 days (median) after receipt of the back injury claim. Computerized database records of work disability 1 year after claim submission were obtained for the primary outcome measure.Results. Nearly 14% (254 of 1843) of the sample were receiving work disability compensation at 1 year. More than one-third of the workers (630 of 1843) received an opioid prescription within 6 weeks, and 50.7% of these (319 of 630) were received at the first medical visit. After adjustment for pain, function, injury severity, and other baseline covariates, receipt of opioids for more than 7 days (odds ratio = 2.2; 95% confidence interval, 1.5-3.1) and receipt of more than 1 opioid prescription were associated significantly with work disability at 1 year.Conclusion. Prescription of opioids for more than 7 days for workers with acute back injuries is a risk factor for long-term disability. Further research is needed to elucidate this association.