Prescription opiate abuse in chronic pain patients: Clinical criteria, incidence, and predictors
Prescription opiate abuse in chronic pain patients: Clinical criteria, incidence, and predictors
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DOI：
10.1097/00002508-199706000-00009
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发表时间：
1997-06-01
影响因子：
2.9
通讯作者：
Chaney, E
中科院分区：
文献类型：
--
作者：
Chabal, C;Erjavec, MK;Chaney, E
目的：阿片类药物常用于治疗慢性非恶性疼痛患者。在慢性疼痛治疗中，处方阿片类药物滥用的定义、发生率和危险因素存在很大争议。本研究在西雅图退伍军人医疗中心完成，旨在建立阿片类药物滥用标准，测试该标准的评分者间可靠性，将该标准应用于一组慢性疼痛患者，并将阿片类药物滥用的风险与酒精和药物测试的结果相关联。设计/结果测量：一个由经验丰富的疼痛提供者组成的委员会根据DSM-III-R参数设计了一个五点处方阿片类药物滥用检查表。然后将标准应用于疼痛诊所招募的患者。该标准的可靠性是由两名熟悉诊所中每位患者的提供者确定的。结果：19%（76/403）的疼痛门诊患者长期使用阿片类药物，34%（26/76）的患者符合一项滥用标准，27.6%（21/76）的患者符合三项或三项以上滥用标准。该标准的评分者间可靠性>0.9。长期阿片类药物使用者（n = 76）和阿片类药物滥用者（n = 21）之间在药物或酒精滥用史或心理社会测试方面没有差异。设计了慢性非恶性疼痛患者阿片类药物处方滥用标准，该标准具有较好的信度，可在正常的临床互动中应用，阿片剂长期使用者在疼痛治疗中成为阿片剂滥用者的百分比在其他人报告的范围内。过去的阿片类药物或酒精滥用或心理社会测试的诊所入院未能预测谁将成为阿片类药物滥用者。该标准可用于识别随后需要更强化治疗或干预的患者，或可用作测试治疗策略有效性的结局指标。
Objectives: Opiates are commonly used to treat patients with chronic nonmalignant pain. There is much controversy over the definition, incidence, and risk factors of prescription opiate abuse in chronic pain treatment. The present study, done at the Seattle VA Medical Center, was designed to create opiate abuse criteria, test inter-rater reliability of the criteria, apply the criteria to a group of chronic pain patients, and correlate the risk of opiate abuse with the results of alcohol and drug testing.Design/Outcome Measures: A committee of experienced pain providers designed a five-point prescription opiate abuse checklist based on DSM-III-R parameters. The criteria were then applied to patients enrolled in the pain clinic. The reliability of the criteria were determined using two providers who were familiar with every patient in the clinic. Drug, alcohol, and psychosocial testing were correlated with the risk of opiate abuse.Results: A total of 19% (76/403) of all pain clinic patients were using chronic opiates, Thirty -four percent (26/76) met one, and 27.6% (21/76) met three or more of the abuse criteria. The criteria had an inter-rater reliability of >0.9. There were no differences between chronic opiate users (n = 76) and opiate abusers (n = 21) for a history of drug or alcohol abuse or on psychosocial testing.Conclusions: Prescription opiate abuse criteria for use in patients with chronic nonmalignant pain were designed, The criteria had good reliability and can be applied during normal clinic interactions, The percentage of chronic opiate users who become opiate abusers in pain treatment is within the range reported by others. Past opiate or alcohol abuse or psychosocial testing on clinic admission failed to predict who would become an opiate abuser. The criteria can be used to identify patients who will subsequently require more intensive treatment or intervention or can be used as an outcome measure to test the effectiveness of treatment strategies.