Importance of Side Effects in Opioid Treatment A Trade-Off Analysis With Patients and Physicians
Importance of Side Effects in Opioid Treatment A Trade-Off Analysis With Patients and Physicians
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DOI：
10.1016/j.jpain.2010.02.007
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发表时间：
2010-11-01
期刊：
影响因子：
4
通讯作者：
Kavanagh, Shane
中科院分区：
文献类型：
--
作者：
Gregorian, Razmic S., Jr.;Gasik, Alexander;Kavanagh, Shane
这项研究考察了疼痛缓解和阿片类药物副作用对患者和医生药物偏好的相对影响。618名患者（302名急性疼痛患者，316名慢性疼痛患者）和325名医生（83名初级保健医生，80名疼痛专家，41名肿瘤学家，40名普通外科医生，40名骨科医生，20名风湿病学家，21名神经科医生）完成了一项网络调查，受访者完成了适应性联合分析（ACA）练习，其中他们表明了自己对20对药物的相对偏好几乎所有患者（96%为慢性患者，92%为急性患者）报告在服用阿片类药物时至少出现一种副作用，但医生估计的大多数阿片类药物副作用的发生率远低于患者报告的发生率。阿片类药物副作用而不是疼痛缓解解释了两种患者药物偏好的大部分差异（慢性患者为74%，急性患者为73%）医生和治疗急性慢性74%(73%)在此练习恶心和呕吐是阿片类药物的主要决定因素的偏好与每个解释的方差在偏好缓解疼痛(21%对25%)恶心和呕吐是最重要的副作用的基础上的疼痛被调查者愿意放弃减少副作用的发生率副作用被确认的重要性在一个开放的问题,51%的结束患者和58%的医生认为减少副作用是对疼痛药物的未满足需求。观点本研究提供了患者和医生对阿片类药物治疗的风险和收益平衡偏好的见解，该信息可以提高对患者需求的理解，并促进将患者偏好纳入治疗选择(C) 2010年由美国疼痛协会
This study examined the relative impact of pain relief and opioid side effects on patients and physicians preferences for medication An Internet survey was completed by 618 patients (302 acute pain 316 chronic pain) and 325 physicians (83 primary care 80 pain specialists 41 oncologists 40 general surgeons 40 orthopedic surgeons 20 rheumatologists 21 neurologists) Respondents completed an Adaptive Conjoint Analysis (ACA) exercise in which they indicated their relative preference for 20 pairs of hypothetical opioid pain medications described by varying levels of pain relief and side effect incidence Almost all patients (96% of chronic 92% of acute) reported experiencing at least 1 side effect while on opioid medication but physician estimated incidence rates of most opioid side effects were much lower than those reported by patients Opioid side effects rather than pain relief explained the majority of variance for medication preference for both patients (74% for chronic 73% for acute) and treating physicians (73% for chronic 74% for acute) in this exercise Nausea and vomiting were major determinants of opioid medication preference with each explaining as much of the variance in preference as did pain relief (21% to 25%) Nausea and vomiting were the most important side effects based on the amount of pain relief that respondents were willing to give up for reducing the incidence of side effects The importance of side effects was confirmed in an open ended question where 51% of patients and 58% of physicians identified side effect reduction as an unmet need for pain medicationsPerspective This study provided insights into patient and physician preferences of the risk and benefit balance of opioid therapy This information could improve understanding of patient needs and facilitate the incorporation of patient preference into therapy choice (C) 2010 by the American Pain Society