RISK OF PRESCRIPTION OPIOID ABUSE IN CHRONIC PAIN TREATMENT

处方阿片类药物滥用是美国阿片类药物/阿片类药物滥用增长最快的形式。 这些药物大多来自止痛处方。关于风险存在争议 滥用和成瘾时，慢性非恶性疼痛治疗处方阿片类药物。的风险 发展滥用或成瘾从来没有被研究在纵向的方式在患者中的初级 开始大部分阿片类药物治疗的护理医生。 一些专家建议不要在这一人群中使用阿片类镇痛药，因为他们认为， 耐受性很快使药物无效，成瘾的风险很高，而其他人说， 成瘾在疼痛患者中是罕见的，并且镇痛会随着时间的推移而持续。两侧均无纵向 用适当的措施来支持他们的论点。无论如何，药物正在 因为疼痛是无处不在的，医生谁开始最多的病人， 是初级保健医生。 我们建议在一个典型的初级保健的大样本（600例患者）中研究疼痛的治疗 不同种族的患者，以确定疼痛缓解是否持续超过24个月， 导致滥用或成瘾的异常行为的频率。终点将基于DSM 滥用或成瘾的诊断。我们将仔细测量被认为会增加风险的基线因素 成瘾，如药物滥用史，家族史和精神疾病的存在， 抑郁和焦虑我们还将监测92名初级保健医生的处方做法， 自愿参加这项研究不排除有药物滥用史的患者 因为这些患者也有慢性疼痛，目前还没有基于证据的指南 这些患者造成的滥用风险增加，也没有什么方法可以用来充分治疗他们的疼痛 没有滥用或复发的迹象 我们的最终目标是预防滥用和改善疼痛治疗。在最后一年， 在这个为期五年的项目中，我们将开始应用从纵向研究中学到的信息， 一套治疗指南，可以在随后的随机对照试验中进行测试， 常规治疗（根据我们的观察性研究定义）。这些治疗指南，根据需要 初级保健医生，将在会议和杂志中传播，如我们目前所述， 将药物滥用意识引入主流医学的计划。

Prescription opioid abuse is the fastest growing form of opiate/opioid abuse in the United States. Most of these medications come from prescriptions written for pain. There is controversy as to the risk of abuse and addiction when chronic non-malignant pain is treated by prescription opioids. The risk of developing abuse or addiction has never been studied in a longitudinal fashion among patients of primary care physicians who initiate most of the opioid treatment. Some experts advise against the use of opioid analgesics in this population because they believe that tolerance soon renders the medication ineffective and the risk of addiction is high while others say that addiction is rare among pain patients and that analgesia continues over time. Neither side has longitudinal studies with appropriate measures to support their arguments. In any case, the medications are being widely prescribed because pain is ubiquitous and the physicians who initiate the greatest number of patients on this treatment are primary care physicians. We propose to study the treatment of pain in a large sample (600 patients) of typical primary care patients who are ethnically diverse to determine whether pain relief continues over 24 months and what is the frequency of aberrant behaviors leading to abuse or addiction. End points will be based on the DSM diagnosis of abuse or addiction. We will carefully measure baseline factors that are thought to increase risk of addiction such as history of substance abuse, family history and presence of psychiatric disorders such as depression and anxiety. We will also monitor prescribing practices of the 92 primary care physicians who have volunteered to be included in the study. Patients with a history of substance abuse will not be excluded because these patients also have chronic pain and at present there are no evidence-based guidelines on the increased risk of abuse posed by these patients nor what methods can be used to treat their pain adequately without the appearance of abuse or relapse. Our ultimate goal is the prevention of abuse and the improvement of pain treatment. During the final year of this five year project, we will begin to apply the information learned from the longitudinal study to develop a package of treatment guidelines that can be tested in a subsequent randomized, controlled trial against treatment as usual (as defined by our observational study). These treatment guidelines, tailored to the needs of primary care physicians, will be disseminated in meetings and journals as described in our current program to bring awareness of substance abuse to mainstream medicine.