Co-morbidity and utilization of medical services by pain patients receiving opioid medications: Data from an insurance claims database
Co-morbidity and utilization of medical services by pain patients receiving opioid medications: Data from an insurance claims database
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DOI：
10.1016/j.pain.2009.01.026
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发表时间：
2009-07-01
期刊：
影响因子：
7.4
通讯作者：
Isenberg, Keith
中科院分区：
文献类型：
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作者：
Cicero, Theodore J.;Wong, Gordon;Isenberg, Keith
我们使用一个大型医疗保险索赔数据库来确定三组：慢性阿片类药物使用组（100 - 180治疗日，N = 3726）；慢性疼痛组的急性阿片类药物使用（63%）和使用所有医疗服务的份额远高于男性，特别是随着年龄的增长。虽然我们的数据表明，慢性疼痛在多学科患者和性别特异性治疗计划中得到最佳管理，但很少有内科医生是主要的，而且通常只有内科医生。此外，我们的数据表明，阿片类药物经常用于通常不适用的疾病（例如关节炎和头痛）或共存的身体疾病（COPD）的禁忌症。最后，我们得出结论，遵守世卫组织镇痛阶梯和其他疼痛治疗指南的情况相对较少：首先，非常适合慢性疼痛的阿片类药物缓释制剂仅在四分之一的患者中使用；其次，选择弱阿片类药物（丙氧芬、可待因和曲马多）或强阿片类药物（如吗啡和羟考酮）似乎是由许多因素驱动的，这些因素与疼痛的强度或持续时间不一定相关。(C) 2009年国际疼痛研究协会。Elsevier B.V.版权所有。
We used a large medical insurance claims database to identify three groups: chronic opioid use (>180 therapeutic days, N = 3726); acute opioid use (63%) in the chronic pain group and used a much greater share of all medical services than males, especially as they grew older. Although our data suggest that chronic pain is optimally managed in a multidisciplinary patient- and gender-specific treatment plan, this was rarely the case with internists being the primary, and often only, physician seen. Moreover, Our data suggest that opioids were often used for conditions in which they are generally not indicated (e.g. arthritis and headaches) or contraindicated by co-existing physical ailments (COPD). Finally, we conclude that adherence to the WHO analgesic ladder and other pain treatment guidelines was relatively infrequent: first, opioid extended release preparations which are ideally Suited for chronic pain were used only in one in four patients; and, second, the selection of a weak (propoxyphene, codeine, and tramadol) or strong opioid (e.g. morphine and oxycodone) seemed to be driven by numerous factors not necessarily related to the intensity or duration of pain. (C) 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.