Association between Lifetime History of Traumatic Brain Injury, Prescription Opioid Use, and Persistent Pain: A Nationally Representative Study.
Association between Lifetime History of Traumatic Brain Injury, Prescription Opioid Use, and Persistent Pain: A Nationally Representative Study.
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创伤性脑损伤的终生史、处方阿片类药物使用和持续性疼痛之间的关联：一项全国代表性研究。
DOI：
10.1089/neu.2020.7496
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发表时间：
2021
影响因子：
4.2
通讯作者：
Dams-O'Connor,Kristen
中科院分区：
文献类型：
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作者：
Kumar,RajG;Ornstein,KatherineA;Corrigan,JohnD;SaykoAdams,Rachel;Dams-O'Connor,Kristen
疼痛在患有创伤性脑损伤（TBI）的成年人中很常见，但关于这一人群中阿片类药物使用率的数据很少。这项回顾性队列研究的目的是在参加健康与退休研究（HRS）的1022名50岁以上成年人的全国代表性样本中评估终身TBI暴露，阿片类药物使用和疼痛之间的关联。我们的主要暴露是通过俄亥俄州州立大学TBI识别方法测量的终生TBI史。在敏感性分析中，我们评估了三种替代TBI暴露（自最近TBI以来的年数、首次TBI时的年龄和终生TBI次数）。我们评估了两个结果：最近使用阿片类药物，以及在两个HRS波上测量的中度至重度疼痛。我们将疼痛分为三组（持续性、间歇性和无痛）。在有和没有TBI的个体中，阿片类药物使用的患病率分别为19.7%和13.6%。在调整年龄，性别和种族后，与没有TBI的个体相比，TBI个体使用阿片类药物的风险增加了52%（相对风险= 1.52，95%置信区间：1.11，2.04）。近期TBI（1-10年前），40岁以上首次TBI和2+终身TBI的个体使用阿片类药物的风险最大。与没有TBI的个体相比，TBI患者持续性疼痛与无疼痛的几率增加了4.9倍，间歇性疼痛与无疼痛的几率增加了1.9倍。与一般人群相比，终身TBI成人的持续性疼痛升高，这可能导致TBI患者，特别是最近受伤或多次终身TBI的患者中阿片类药物使用增加。
Pain is common among adults with traumatic brain injury (TBI), yet little data exist regarding prevalence of opioid use in this population. The objective of this retrospective cohort study was to evaluate the association between lifetime TBI exposure, opioid use, and pain in a nationally representative sample of 1022 adults aged 50+ who participated in the Health and Retirement Study (HRS). Our primary exposure was lifetime TBI history measured via the Ohio State University TBI Identification Method. We evaluated three alternate TBI exposures (years since most recent TBI, age at first TBI, and number of lifetime TBIs) in sensitivity analyses. We evaluated two outcomes: recent opioid medication use, and moderate-to-severe pain measured over two HRS waves. We classified three pain groups (persistent, intermittent, and no pain). Prevalences of opioid use among individuals with and without TBI were 19.7% and 13.6%, respectively. After adjustment for age, sex, and race, individuals with TBI had a 52% increased risk for opioid use compared with individuals without TBI (relative risk = 1.52, 95% confidence interval: 1.11, 2.04). Individuals with recent TBI (1–10 years ago), first TBI after age 40+, and 2+ lifetime TBIs had greatest risk for opioid use. Compared with individuals without TBI, individuals with TBI had 4.9-times increased odds for persistent versus no pain, and 1.9-times increased odds of intermittent versus no pain. Persistent pain among adults with lifetime TBI is elevated compared with the general population, which may contribute to increased opioid use among persons with TBI, particularly those with recent injuries or multiple lifetime TBIs.