A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity
A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity
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DOI：
10.1186/1472-6963-5-3
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发表时间：
2005-01-13
影响因子：
2.8
通讯作者：
Pignone, MP
中科院分区：
文献类型：
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作者：
Chelminski, PR;Ives, TJ;Pignone, MP
背景：慢性非癌性疼痛是一种常见问题，通常伴有精神共病和残疾。多学科疼痛管理计划的有效性在试验前后 3 个月内进行了测试。方法：学术全科医学诊所的提供者转介患有慢性非癌症疼痛的患者参加一个结合了内科医生、临床药剂师和精神科医生技能的计划。患者要么正在接受阿片类药物治疗，要么正在考虑接受阿片类药物治疗。干预措施包括结构化临床评估、每月随访、疼痛合同、药物滴定和精神病咨询。使用简要疼痛量表 (BPI)、流行病学研究中心抑郁量表 (CESD) 和疼痛失能指数 (PDI) 对基线和 3 个月时的疼痛、情绪和功能进行评估。监测患者是否滥用药物。结果：85 名患者入组。平均年龄为 51 岁，60% 为男性，78% 为白种人，93% 正在接受阿片类药物治疗。基线平均疼痛为 6.5（11 分制）。 CESD 平均分为 24.0，PDI 平均分为 47.0。 63 名患者 (73%) 完成了 3 个月的随访。十五人在发现药物滥用后退出了该计划。在完成 3 个月随访的患者中，平均疼痛评分改善至 5.5 (p = 0.003)。平均 PDI 得分提高至 39.3 (p < 0.001)。平均 CESD 评分降低至 18.0 (p < 0.001)，抑郁患者比例从 79% 下降至 54% (p = 0.003)。 27 名患者 (32%) 发现药物滥用。结论：初级保健疾病管理计划在三个月内改善了接受阿片类药物治疗的慢性非癌症疼痛患者的疼痛、抑郁和残疾评分。药物滥用和抑郁症很常见，许多发现药物滥用的患者在不再服用阿片类药物后退出了该计划。对慢性疼痛患者的有效护理应包括对这些共存疾病进行严格评估和治疗，并大力确保随访。
Background: Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial.Methods: Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse.Results: Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% ( p = 0.003). Substance misuse was identified in 27 patients (32%).Conclusions: A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up.