The association of persistent pain with out-patient addiction treatment outcomes and service utilization
The association of persistent pain with out-patient addiction treatment outcomes and service utilization
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DOI：
10.1111/j.1360-0443.2008.02358.x
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发表时间：
2008-12-01
期刊：
影响因子：
6
通讯作者：
Saxon, Andrew J.
中科院分区：
文献类型：
--
作者：
Caldeiro, Ryan M.;Malte, Carol A.;Saxon, Andrew J.
旨在估计门诊成瘾治疗退伍军人中持续性疼痛的患病率，并检查相关的成瘾治疗结果以及医疗和精神科服务的使用。对一项前瞻性随机对照试验的数据进行分析，该试验比较了有物质依赖的退伍军人的现场与转诊初级护理（n = 582），不包括在退伍军人事务部（VA）门诊成瘾治疗中心的 12 个月研究期间至少进行过一次随访访谈的阿片类药物依赖。疼痛状态被分类为持续性（疼痛为持续性疼痛）在所有时间点均评定为中度至非常严重）、低度（在所有时间点均评定为无至轻微疼痛）或间歇性（所有其他）。主要结果指标是成瘾治疗保留率、成瘾严重指数 (ASI) 酒精和药物综合评分、VA 服务利用率和治疗费用。 共有 33.2% 的退伍军人报告持续性疼痛，47.3% 报告间歇性疼痛。所有组都受益于成瘾治疗，但患有持续性疼痛的退伍军人接受治疗的天数估计减少了 35.1 天 [95% 置信区间 (CI) = -64.1, -6.1, P = 0.018]，在 12 个月时戒酒或戒毒的可能性较小 [比值比 (OR)(adj) = 0.52； 95% CI = 0.30,0.89; [P = 0.018]，12 个月时 ASI 酒精综合评分较差（beta(adj) = 0.09；95% CI = 0.02,0.15；P = 0.007），更有可能住院治疗（OR(adj) = 2.70；95% CI = 1.02,7.13；P = 0.046），并且总服务成本较高与低疼痛者相比（17 766 美元 vs 13 261 美元，P = 0.012）。持续性疼痛在接受门诊成瘾治疗的退伍军人中很常见，并且与低疼痛者相比，其戒酒率较低、饮酒严重程度较差以及服务利用率和成本较高。
To estimate the prevalence of persistent pain among veterans in out-patient addiction treatment and examine associated addiction treatment outcomes and medical and psychiatric service use.Analysis of data from a prospective randomized controlled trial comparing on-site versus referral primary care of veterans with substance dependence (n = 582), excluding opioid dependence who had at least one follow-up interview during the 12-month study period in a Veterans Affairs (VA) out-patient addiction treatment center.Pain status was classified as persistent (pain was rated moderate to very severe at all time-points), low (pain was rated none to mild at all time-points) or intermittent (all others). Main outcome measures were addiction treatment retention, addiction severity index (ASI) alcohol and drug composite scores, VA service utilization and treatment costs.A total of 33.2% of veterans reported persistent pain and 47.3% reported intermittent pain. All groups benefited from addiction treatment, but veterans with persistent pain were in treatment for an estimated 35.1 fewer days [95% confidence interval (CI) = -64.1, -6.1, P = 0.018], less likely to be abstinent from alcohol or drugs at 12 months [odds ratio (OR)(adj) = 0.52; 95% CI = 0.30,0.89; P = 0.018], had worse ASI alcohol composite scores at 12 months (beta(adj) = 0.09; 95% CI = 0.02,0.15; P = 0.007), were more likely to be medically hospitalized (OR(adj) = 2.70; 95% CI = 1.02,7.13; P = 0.046) and had higher total service costs compared to those with low pain ($17 766 versus $13 261, P = 0.012).Persistent pain is common among veterans in out-patient addiction treatment and is associated with poorer rates of abstinence, worse alcohol use severity and greater service utilization and costs than those with low pain.