Relationship Between Opioid Use and Pain Severity Ratings in Workers With Low Back Pain.
Relationship Between Opioid Use and Pain Severity Ratings in Workers With Low Back Pain.
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阿片类药物使用与腰痛工人疼痛严重程度评级之间的关系。
DOI：
10.1097/jom.0000000000001673
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发表时间：
2019
影响因子：
3.2
通讯作者：
BackWorksStudyTeam
中科院分区：
文献类型：
--
作者：
Cheng,Melissa;Thiese,MatthewS;Wood,EricM;Kapellusch,Jay;Foster,James;Drury,David;Merryweather,Andrew;Hegmann,KurtT;BackWorksStudyTeam
目的：这项横断面分析的主要目的是确定自我报告的下腰痛(LBP)评分与阿片类药物使用之间的关系。方法：在基线时，受试者完成一份计算机化的问卷。由住院医师或注册治疗师在注册医师的指导下进行结构化访谈。结果：LBP评分最差的终生患病率(0~10)与终生使用阿片类药物的患病率之间存在显著的统计学意义的非线性关系。那些一生中最糟糕的LBP疼痛评分较低的人和那些LBP评分较高的人更有可能服用阿片类药物。令人惊讶的是，那些中等疼痛等级的人使用阿片类药物的可能性最小。结论：这项研究发现，严重疼痛等级低和高的工人比中度疼痛等级的工人使用阿片类药物的可能性更高。我们还发现，用于剧烈疼痛的阿片类药物的使用有所增加。背景下腰痛(LBP)是一种常见且代价高昂的健康疾病，仅在美国每年就估计造成120亿美元的直接和间接成本。1，2全世界每三个成年人中至少有一个在任何给定的时间患有LBP，也称为时点流行率。3终生患病率估计在65%到78%之间，2，4尽管考虑到一些研究包括可能尚未经历过疼痛的年轻人以及可能没有回忆起先前疼痛的老年人，估计可能被低估了。在美国，大约20%的工人索赔是因为背部疼痛。5对于LBP，有多种治疗选择，从非处方药到锻炼，再到侵入性外科手术。6 LBP的一种常见治疗方法是阿片类药物，6在美国，LBP是开阿片类药物的最常见原因。7从2000年开始，当退伍军人健康管理局、联合委员会和其他组织采纳了“疼痛是第五生命体征”的想法时，治疗疼痛的阿片类药物处方率急剧上升。2002至2005年间，华盛顿州42%的急性LBP损伤工人接受了阿片类药物治疗。7然而，使用阿片类药物伴随着依赖、成瘾和不良健康结果等风险，直至死亡。8-10此外，据报道，阿片类药物的使用与更糟糕的结果有关，包括医疗成本增加、重返工作岗位的比率更低以及手术结果更差。2、7-25最近，包括疾病控制和预防中心(CDC)、美国职业与环境医学院(ACOEM)在内的许多专业组织以及各个国家和州都制定了指南，建议更严格和明智地使用阿片类药物。14、17、20、26、27然而，据我们所知，还没有一项基于人群的研究将疼痛严重程度分级与处方阿片类药物使用联系起来。关于自我感知的疼痛水平如何帮助指导阿片类药物的使用，人们知之甚少。这项研究将评估患者的LBP评分与治疗LBP的处方阿片类药物使用之间的潜在关系。这项研究的目的是确定疼痛评分是否与治疗LBP的处方阿片类止痛药有关。我们假设阿片类药物的使用和疼痛评分之间存在单调的线性关系，使得患者的疼痛评分每增加一个单位，患者使用阿片类药物的可能性就会线性增加。
Objective:The primary goal of this cross-sectional analysis was to determine the relationships between self-reported low back pain (LBP) ratings and use of opioid medications.Methods:At baseline, subjects completed a computerized questionnaire. Structured interviews were conducted by residents or certified therapists under the direction of board-certified physicians.Results:There was a statistically significant nonlinear relationship between lifetime prevalence of worst LBP rating (0 to 10) and lifetime prevalence of opioid use. Those with a low pain rating for worst lifetime LBP and those with high LBP ratings were significantly more likely to have been prescribed opioids. Surprisingly, those with moderate pain ratings were the least likely to have used opioids.Conclusion:This study found a higher use of opioids between workers with low and high severe pain rating then those with moderate pain. We also found an increase of opioid use for severe pain.BACKGROUNDLow back pain (LBP) is a common and costly health condition, accounting for an estimated 12 billion dollars in direct and indirect costs a year in the US alone. 1, 2 At least one in every three adults suffer from LBP at any given time throughout the world, also known as point prevalence. 3 Lifetime prevalence estimates range from 65% to 78%, 2, 4 although underestimation is likely considering that some studies included younger individuals who may have not yet experienced pain as well as older individuals who may have not recalled prior pain. In the US, approximately 20% of all worker's compensation claims are for back pain. 5 Multiple treatment options, ranging from over-the-counter medication to exercise to invasive surgical procedures, exist for LBP. 6 One frequent treatment for LBP is opioid medication, 6 with LBP being the most common reason for prescribing opioids in the US. 7 Starting in 2000, when the Veterans Health Administration, the Joint Commission, and other organizations adopted the idea that “pain is the fifth vital sign,” opioid prescription rates for the treatment of pain dramatically increased. Between 2002 and 2005, 42% workers in Washington State with an acute LBP injury were treated with opioids. 7 Yet, the use of opioid medication is accompanied by risks such as dependence, addiction, and poor health outcomes up to and including death. 8–10 Furthermore, opioid use is reportedly associated with worse outcomes, including increased medical costs, lower rates of return to work, and worse surgical outcomes. 2, 7–25 Recently, many professional organizations, including the Centers for Disease Control and Prevention (CDC), the American College of Occupational and Environmental Medicine (ACOEM), and various countries and states have created guidelines that recommend more stringent and judicious use of opioids. 14, 17, 20, 26, 27 However, to our knowledge, there has not been a population-based study correlating pain severity rating and prescription opioid use. Little is known about how self-perceived pain levels help guide opioid medication use. This study will evaluate the potential relationship between patients’ LBP ratings and prescribed opioid use for treatment of LBP. The aim of this study is to determine whether pain rating scores are related to prescribed opioids pain medication for treatment of LBP. We hypothesize that there is a monotonic linear relationship between opioid use and pain score such that patients with each increase in one unit pain rating will have a linear increase in probability of having used of opioid medications.METHODS