Longitudinal pattern of pain medication utilization in peripheral neuropathy patients
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients
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DOI：
10.1097/j.pain.0000000000001439
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发表时间：
2019-03-01
期刊：
影响因子：
7.4
通讯作者：
Burke, James F.
中科院分区：
文献类型：
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作者：
Callaghan, Brian C.;Reynolds, Evan;Burke, James F.
我们的目的是调查周围神经病患者神经性疼痛药物的模式和利用。使用2001年至2014年的私人保险医疗索赔数据库，我们在排除其他慢性疼痛疾病后，确定了一个回顾性周围神经病变患者（经验证的ICD-9定义）队列。结果指标包括阿片类药物处方、长期阿片类药物治疗（持续供应≥ 90天）、指南推荐的疼痛性周围神经病变药物（5-羟色胺再摄取抑制剂、三环类抗抑郁药和加巴喷丁类药物）和疼痛专家（神经科医生、理疗师和麻醉师）。多变量逻辑回归用于评估患者水平因素与这些结果的相关性。周围神经病变人群包括14，426例患者，平均（SD）年龄为43.1岁（2.8），52.4%的男性在诊断前随访3.1（1.7）年，诊断后随访4.5（1.4）年。在这一人群中，65.9%接受≥ 1次阿片类药物处方，8.8%接受慢性阿片类药物治疗。在接受慢性阿片类药物治疗的患者中，只有26.4%在慢性阿片类药物状态之前接受了指南推荐的药物治疗。对于指南推荐的药物，35.7%接受>= 1 12.4% >= 2，3.8% >= 3种不同的药物。没有患者水平的因素与阿片类药物的高利用率（初始和长期使用）和指南推荐的药物利用率低相关。疼痛专家与高阿片类药物利用率和高指南推荐的药物利用率相关。总之，尽管很少有患者接受一种以上指南推荐的药物治疗，但在周围神经病变人群中，阿片类药物治疗开始和过渡到慢性阿片类药物治疗是常见的。需要努力减少阿片类药物的使用和增加指南推荐的药物使用，以改善目前的神经性疼痛治疗。
We aimed to investigate the pattern and utilization of neuropathic pain medications in peripheral neuropathy patients. Using a privately insured, health care claims database from 2001 to 2014, we identified a retrospective cohort of incident peripheral neuropathy patients (validated ICD-9 definition) after excluding other chronic pain conditions. Outcome measures included opioid prescriptions, chronic opioid therapy (greater than or equal to 90 days of continuous supply), guideline-recommended medications for painful peripheral neuropathy (serotonin reuptake inhibitors, tricyclic antidepressants, and gabapentinoids), and pain specialists (neurologists, physiatrists, and anesthesiologists). Multivariable logistic regression was used to evaluate associations of patient-level factors with these outcomes. The peripheral neuropathy population included 14,426 individuals with a mean (SD) age of 43.1 years (2.8) and 52.4% men followed for 3.1 (1.7) years before and 4.5 (1.4) years after the diagnosis. In this population, 65.9% received >= 1 opioid prescription, and 8.8% received chronic opioid therapy. Of those receiving chronic opioid therapy, only 26.4% received a guideline-recommended medication before chronic opioid status. For guideline-recommended medications, 35.7% received >= 1 12.4% >= 2, and 3.8% >= 3 different medications. No patient-level factors were associated with both high opioid utilization (initiation and chronic use) and low guideline-recommended medication utilization. Pain specialists were associated with high opioid utilization and high guideline-recommended medication utilization. In conclusion, opioid initiation and transition to chronic opioid therapy are frequent in a peripheral neuropathy population despite few patients receiving more than one guideline-recommended medication. Efforts to decrease opioid utilization and increase guideline-recommended medication use are needed to improve current neuropathic pain treatment.