Understanding the causes of problematic pain management in sickle cell disease: Evidence that pseudoaddiction plays a more important role than genuine analgesic dependence
Understanding the causes of problematic pain management in sickle cell disease: Evidence that pseudoaddiction plays a more important role than genuine analgesic dependence
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DOI：
10.1016/j.jpainsymman.2003.12.001
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发表时间：
2004-02-01
影响因子：
4.7
通讯作者：
Burton, B
中科院分区：
文献类型：
--
作者：
Elander, J;Lusher, J;Burton, B
镰状细胞病（SCD）疼痛发作的治疗有时会因患者和工作人员之间的纠纷以及患者行为引起对镇痛剂滥用的担忧而变得复杂。这些引起关注的行为可能是由于镇痛药依赖引起的药物寻求，也可能是由于疼痛治疗不足引起的假成瘾。为了对引起关注的行为进行系统的评估，并检查它们与其他因素的关系，包括DSM-IV物质依赖症状，对SCD患者进行了单独的深入访谈，以应用预先建立的引起关注行为的标准。这些包括与工作人员发生纠纷、篡改止痛剂输送系统、将处方止痛剂从一个人传递给另一个人、被怀疑或指控滥用止痛剂、自行出院、从多个来源获得止痛剂处方、使用非法药物和注射止痛剂。还对物质依赖的疼痛相关症状进行了评估（其中行为类似于物质依赖，但反映了管理疼痛的尝试，增加。假性成瘾的风险），物质依赖的非疼痛相关症状（物质依赖反映了疼痛管理以外的镇痛剂使用）和疼痛应对策略（使用疼痛应对策略问卷）。提高关注行为评估的评分员间信度较高，Kappa系数为0.63 ~ 1.0。最常见的引起关注的行为是与工作人员就疼痛或止痛药发生争执。最不常见的是篡改止痛剂输送系统和在医院患者之间传递止痛剂。减少忽视疼痛作为一种应对策略，使医院中引起关注行为的几率增加了8倍，而每增加一个与疼痛相关的物质依赖症状，则增加了一倍多。物质依赖的非疼痛相关症状对引起关注行为没有独立影响。引起关注的行为与疼痛行为更密切相关，这些行为使患者容易误解物质依赖，而不是真正的物质依赖。研究结果表明，如何假成瘾会对医院的疼痛管理产生不利影响，并建议应更加重视患者的疼痛和镇痛需求时，在医院的关注提高行为。(C)2004年美国癌症疼痛缓解委员会。爱思唯尔公司出版All rights reserved.
Treatment of painful episodes in sickle cell disease (SCD) is sometimes complicated by disputes between patients and staff and patient behaviors that raise concerns about analgesic misuse. Those concern-raising behaviors could indicate either drug seeking caused by analgesic dependence or pseudoaddiction caused by undertreatment of pain. To make a systematic assessment Of concern-raising behaviors and examine their associations with other factors, including DSM-IV symptoms of substance dependence, individual, in-depth interviews with SCD patients were conducted to apply pre-established criteria for concern-raising behaviors. These included disputes with staff, tampering with analgesic delivery systems, passing prescribed analgesics from one person to another, being suspected or accused of analgesic misuse, self-discharging from hospital, obtaining analgesic prescriptions from multiple sources, using illicit drugs, and injecting analgesics. Assessments were also made of pain-related symptoms of substance dependence (where behaviors resemble substance dependence but reflect attempts to manage pain, increasing. the risk of pseudoaddiction), non-pain-related symptoms of substance dependence (where substance dependence reflects analgesic use beyond pain management), and pain coping strategies (using the Pain Coping Strategies Questionnaire). Inter-rater reliability for the assessment Of concern-raising behaviors was high, with Kappa coefficients of 0.63 to 1.0. The most frequent concern-raising behaviors were disputes with staff about pain or analgesics. The least frequent were tampering with analgesic delivery systems and passing analgesics between patients in hospital. The odds of concern-raising behaviors in hospital were raised eightfold by less use of ignoring pain as a coping strategy, and more than doubled by each additional pain-related symptom of substance dependence. Non-pain-related symptoms of substance dependence had no independent effect on concern-raising behaviors. Concern-raising behaviors were more closely associated with pain behaviors that make patients vulnerable to misperceptions of substance dependence than they were with genuine substance dependence. The results show how pseudoaddiction can adversely influence hospital pain management, and suggest that more emphasis should be placed on patients' pain and analgesic needs when responding to concern-raising behaviors in hospital. (C) 2004 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.