Persistent pain is associated with substance use after detoxification: a prospective cohort analysis
Persistent pain is associated with substance use after detoxification: a prospective cohort analysis
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DOI：
10.1111/j.1360-0443.2007.01759.x
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发表时间：
2007-05-01
期刊：
影响因子：
6
通讯作者：
Samet, Jeffrey H.
中科院分区：
文献类型：
--
作者：
Larson, Mary Jo;Paasche-Orlow, Michael;Samet, Jeffrey H.
目的 检验以下假设：持续性疼痛与戒毒后物质使用几率增加相关。设计对参加随机对照试验 (RCT) 的前瞻性队列的数据进行分析，以改善与初级医疗保健的联系。制定城市住宅戒毒计划。参与者 参加随机对照试验的成年人 (n = 397)，以海洛因、酒精或可卡因作为选择物质，并至少进行一次后续访谈。测量关键的自变量是疼痛状态：持续性疼痛（在所有可用的访谈中为中度至非常严重的疼痛）、无疼痛（在所有可用的访谈中为轻度疼痛或较少）和间歇性疼痛（所有其他）。有四个感兴趣的结果：自我报告使用任何物质；使用海洛因/阿片类药物；大量饮酒；戒毒后 24 个月使用可卡因。多变量逻辑回归控制了几个协变量，包括人口统计、身体/性虐待、抑郁症状、随访持续时间和研究开始时的成瘾严重程度。研究结果 戒毒患者中疼痛很常见； 16% 患有持续性疼痛，54% 患有间歇性疼痛。在 24 个月的随访中，持续性疼痛与使用任何物质 [调整比值比 (AOR) 4.2，95% 置信区间 (CI) 1.9-9.3]、海洛因/阿片类药物使用（AOR 5.4，95% CI 2.1-13.8）和大量饮酒（AOR 2.2，95% CI 1.0-4.5）的几率增加相关。还观察到使用可卡因的几率在统计学上没有显着增加（AOR 2.0，95% CI 0.9-4.6）。结论 在离开住宅戒毒所的个体中，慢性疼痛是一个常见问题，并且与戒毒后长期物质使用独立相关。将疼痛视为接受戒毒的成人中可治疗的慢性疾病，为改善长期临床结果提供了潜在的机会，并需要进一步的干预研究。
Aims To test the hypothesis that persistent pain is associated with an increased odds of substance use after detoxification. Design Analysis of data from a prospective cohort enrolled in a randomized controlled trial (RCT) to improve linkage with primary medical care. Setting An urban residential detoxification program. Participants Adults (n = 397) enrolled in the RCT with heroin, alcohol or cocaine as a substance of choice and at least one follow-up interview. Measurements The key independent variable was pain status: persistent pain (moderate to very severe pain at all available interviews), no pain (mild pain or less at all available interviews) and intermittent pain (all others). There were four outcomes of interest: self-reported use of any substance; heroin/opioid use; heavy alcohol use; and cocaine use 24 months after detoxification. Multivariable logistic regression controlled for several covariates including demographics, physical/sexual abuse, depressive symptoms, duration of follow-up and addiction severity at study entry. Findings Pain in detoxification patients was common; 16% had persistent pain and 54% had intermittent pain. Persistent pain was associated with an increased odds for use of any substance [adjusted odds ratio (AOR) 4.2, 95% confidence interval (CI) 1.9-9.3], heroin/opioid use (AOR 5.4, 95% CI 2.1-13.8) and heavy alcohol use (AOR 2.2, 95% CI 1.0-4.5) at the 24-month follow-up. A statistically non-significant increase in the odds of cocaine use (AOR 2.0, 95% CI 0.9-4.6) was also observed. Conclusions Among individuals leaving residential detoxification, chronic pain is a common problem and is associated independently with long-term substance use after detoxification. Addressing pain as a treatable chronic condition among adults receiving detoxification presents a potential opportunity to improve long-term clinical outcomes and warrants further intervention research.