Predicting Opioid Use, Increased Health Care Utilization and High Costs for Musculoskeletal Pain: What Factors Mediate Pain Intensity and Disability?
Predicting Opioid Use, Increased Health Care Utilization and High Costs for Musculoskeletal Pain: What Factors Mediate Pain Intensity and Disability?
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DOI：
10.1016/j.jpain.2019.06.004
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发表时间：
2020-01-01
期刊：
影响因子：
4
通讯作者：
George, Steven Z.
中科院分区：
文献类型：
--
作者：
Lentz, Trevor A.;Rhon, Daniel, I;George, Steven Z.
本研究确定了在对肌肉骨骼疼痛进行初步评估后的一年内，疼痛强度和残疾对医疗保健利用（具体情况下的医疗保健就诊次数、事件和慢性阿片类药物使用）和成本（具体情况下的总医疗费用和总体医疗费用）的预测能力。我们探索了疼痛灾难化和症状的空间分布（即身体图症状评分）作为这些关系的中介。接受肌肉骨骼损伤初步护理的 283 名军人完成了特定地区的残疾测量、数字疼痛评级量表、疼痛灾难化量表和身体疼痛图。疼痛强度预测所有结果，而残疾仅预测阿片类药物的使用。没有观察到阿片类药物使用结果的中介作用，而疼痛灾难性部分介导了疼痛强度和就诊次数之间的关系。疼痛灾难化和症状的空间分布完全调节了疼痛强度和成本结果之间的关系。疼痛灾难化和症状空间分布的中介效应是特定于结果的，并且对于成本结果观察得更一致。较高的疼痛强度可能会推动更多针对具体情况的医疗保健利用和阿片类药物的使用，而更高的灾难性和更大的症状空间分布可能会导致更高的服务成本。 观点：本文探讨了有助于解释疼痛强度和残疾之间关系的潜在特征，以及医疗保健利用和成本的结果。医疗保健系统可以利用这些发现，通过考虑对医疗保健使用结果和服务成本产生不同影响的因素来完善基于价值的预测模型。 (C) 2020 年美国疼痛研究协会。由爱思唯尔公司出版。版权所有%S1526-5900(20) X0009-5%202001/02%21%1%2%135%145% ELE\gdef\pts@issuepubyear{2020}保留
This study determined the predictive capabilities of pain intensity and disability on health care utilization (number of condition-specific health care visits, incident, and chronic opioid use) and costs (total condition-specific and overall medical costs) in the year following an initial evaluation for musculoskeletal pain. We explored pain catastrophizing and spatial distribution of symptoms (ie, body diagram symptom score) as mediators of these relationships. Two hundred eighty-three military service members receiving initial care for a musculoskeletal injury completed a region-specific disability measure, numeric pain rating scale, Pain Catastrophizing Scale, and body pain diagram. Pain intensity predicted all outcomes, while disability predicted incident opioid use only. No mediation effects were observed for either opioid use outcome, while pain catastrophizing partially mediated the relationship between pain intensity and number of health care visits. Pain catastrophizing and spatial distribution of symptoms fully mediated the relationship between pain intensity and both cost outcomes. The mediation effects of pain catastrophizing and spatial distribution of symptoms are outcome specific, and more consistently observed for cost outcomes. Higher pain intensity may drive more condition-specific health care utilization and use of opioids, while higher catastrophizing and larger spatial distribution of symptoms may drive higher costs for services received.Perspective: This article examines underlying characteristics that help explain relationships between pain intensity and disability, and the outcomes of health care utilization and costs. Health care systems can use these findings to refine value-based prediction models by considering factors that differentially influence outcomes for health care use and cost of services. (C) 2020 U.S. Association for the Study of Pain. Published by Elsevier Inc. All rights%S1526-5900(20) X0009-5%202001/02%21%1%2%135%145% ELE\gdef\pts@issuepubyear{2020}reserved