Prescription Patterns of Pain Medicine Physicians
Prescription Patterns of Pain Medicine Physicians
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DOI：
10.1111/papr.12011
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发表时间：
2013-07-01
期刊：
影响因子：
2.6
通讯作者：
Avram, Michael J.
中科院分区：
文献类型：
--
作者：
Benzon, Honorio T.;Kendall, Mark C.;Avram, Michael J.
目的：我们的研究调查了3个美国疼痛学会的医生成员，以确定处方模式以及这些做法是否反映了当前的专家意见。方法：2010年1月至2011年1月共向2938名医师发送3封邮件。问卷包含49个问题，主题涉及阿片类药物、抗抑郁药、抗惊厥药以及对不同疼痛综合征的偏好。结果：共有474名医生回应，代表16%的回报率。72%的人要求患者签署阿片类药物协议，59%的人要求随机尿检，13%的人等到美沙酮的剂量在100到150毫克之间才将药物转换为另一种阿片类药物，85%的人认为与驾驶有关的阿片类药物没有最大剂量。大多数应答者给白种人和亚洲人开可待因。42%的人说对乙酰氨基酚的最大日剂量是3000毫克，75%的人会减少中度或重度饮酒者的剂量。54%的医生在开三环类抗抑郁药时根本不做心电图检查。结论：与阿片类药物协议、尿药检、对乙酰氨基酚和神经性疼痛治疗有关的反应令人放心，因为它们防止了阿片类药物的误用和滥用，防止了对乙酰氨基酚引起的肝毒性，并反映了循证治疗。然而，我们发现了知识上的差距，包括某些人群的可待因处方和抗抑郁药患者的心电图使用。对治疗慢性疼痛的医生进行进一步的药理学教育是必要的。
Objectives: Our study surveyed physician members of 3 American pain societies to determine prescription patterns and whether these practices reflect current expert opinion. Methods: We sent 3 mailings to 2938 physicians from January 2010 to January 2011. The questionnaire contained 49 questions on topics related to opioids, antidepressants, anticonvulsants, and preferences for the different pain syndromes.Results: A total of 474 physicians responded, representing a 16% return. Seventy-two percent ask patients to sign an opioid agreement, 59% order random urine drug testing, 13% wait until the dose of methadone is between 100 and 150 mg before converting the drug to another opioid, and 85% do not think there is a maximum dose of opioids with respect to driving. Most responders prescribe codeine to Caucasians and Asians. While 42% stated that the maximum daily dose of acetaminophen is 3000 mg, 75% would decrease the dose in patients who are moderate or heavy drinkers. Fifty-four percent do not order an ECG at all when prescribing tricyclic antidepressants.Conclusions: The responses pertaining to opioid agreements, urine drug testing, acetaminophen, and treatment for neuropathic pain are reassuring in that they prevent misuse and abuse of opioids, prevent acetaminophen-induced hepatotoxicity, and reflect evidence-based treatments. However, we identified gaps in knowledge, including the prescription of codeine in certain populations and the use of electrocardiogram in patients on antidepressants. Further education of physicians who treat chronic pain pharmacologically is warranted.