Transition to Long-Term Opioid Use Among Older Adults with Chronic Pain

背景和目标-长期阿片类药物治疗慢性非癌性疼痛（CNCP）近年来急剧增加，特别是在中老年人中。现在有超过800万美国成年人使用阿片类药物来长期治疗CNCP，但这些患者在疼痛控制和心理社会结果方面存在很大的个体差异。在慢性阿片类药物治疗中，区分可能出现阿片类药物相关困难和不利心理社会结果的患者和可能出现有利结果的患者，现在是一个具有重大临床和公共卫生意义的问题。本研究将明确开始慢性阿片类药物治疗的患者的个体风险，为早期识别心理和功能不良预后高危患者奠定基础。在开始长期使用阿片类药物的中老年人中，本研究将：1)确定持续使用阿片类药物的预测因素；2)评估心理社会功能障碍的危险因素；并且，3)开发实用的方法来早期识别患者在不利的社会心理结果的风险增加。方法：对1500名开始长期使用处方阿片类药物的中老年CNCP患者进行队列研究。数据将通过基线和3个月和12个月后随访时的研究参与者访谈以及健康计划电子病历数据获得。利用这些数据，拟议的研究将解决以下具体目标：目标1：确定阿片类药物长期使用的预测因素-将评估基线变量，以确定一年内阿片类药物持续使用的预测因素，并了解影响持续使用的因素。目的2：确定社会心理功能障碍的危险因素-在一年的随访中将评估开始长期使用阿片类药物的患者的社会心理功能障碍的危险因素。目标3：建立临床预测模型——将根据基线数据建立一年内心理社会功能障碍的临床预测模型。影响：本研究将为CNCP患者开始慢性阿片类药物治疗的不良心理社会结局的发展和预测提供新的见解。这项研究将有助于临床医生在阿片类药物使用的早期识别可能持续使用阿片类药物的患者和那些具有不利心理社会结局高风险的患者。这将为降低这些患者不良心理和功能结果的风险提供机会。1

DESCRIPTION (provided by applicant): Background and goals - Long-term opioid therapy for chronic non-cancer pain (CNCP) has increased dramatically in recent years, especially among middle aged and older adults. More than 8 million American adults now use opioids for long-term management of CNCP, but there are substantial individual differences in pain control and psychosocial outcomes among these patients. Differentiating patients likely to experience favorable outcomes from those who may have opioid-related difficulties and unfavorable psychosocial outcomes on chronic opioid therapy is now a problem of substantial clinical and public health significance. This research will clarify individual risks among patients initiating chronic opioid therapy, laying the foundation for early identification of patients at high risk of unfavorable psychological and functional outcomes. Among middle aged and older adults initiating long-term opioid use, this research will: 1) identify predictors of sustained opioid use; 2) evaluate risk factors for psychosocial dysfunction; and, 3) develop practical methods for early identification of patients at increased risk of unfavorable psychosocial outcomes. Methods - A Study Cohort will be formed with 1500 middle aged and older CNCP patients initiating long- term use of prescribed opioids. Data will be obtained through study participant interviews at baseline and at follow-ups 3 and 12 months later, and from health plan electronic medical records data. Using these data, the proposed research will address the following specific aims: Aim 1: Identify predictors of long-term opioid use - Baseline variables will be evaluated to identify predictors of continued opioid use at one year and to understand factors influencing sustained use. Aim 2: Identify risk factors for psychosocial dysfunction - Risk factors for psychosocial dysfunction at one year follow-up will be evaluated among patients initiating long-term opioid use. Aim 3: Develop clinical prediction models - Clinical prediction models for psychosocial dysfunction at one year will be developed from baseline data. Impact: This research will yield new insights into the development and prediction of unfavorable psychosocial outcomes among CNCP patients initiating chronic opioid therapy. This research will help practicing clinicians identify, early in an episode of opioid use, patients likely to sustain opioid use and those at high risk of unfavorable psychosocial outcomes. This will afford opportunities to reduce risks of unfavorable psychological and functional outcomes among these patients. 1 PUBLIC HEALTH RELEVANCE: More than 8 million American adults now use opioids for long-term management of chronic non-cancer pain, but there are substantial individual differences in pain control and psychosocial outcomes among these patients. Differentiating patients likely to experience favorable outcomes from those who may have opioid- related difficulties and unfavorable psychosocial outcomes on chronic opioid therapy is now a problem of substantial clinical and public health significance. This research will clarify individual risks among patients initiating chronic opioid therapy, laying the foundation for early identification of patients at high risk of unfavorable psychological and functional outcomes. 1