Correlates and outcomes of opioid dose escalation among chronic pain patients

描述（由申请人提供）：近年来，长期阿片类药物治疗慢性非癌性疼痛（CNCP）的使用急剧增加。虽然慢性阿片类药物治疗越来越普遍，但患者之间的治疗结果存在显着差异。提供者经常在疼痛恶化期间增加阿片类药物剂量，这有可能降低疼痛强度，但可能增加药物相关不良反应或阿片类药物滥用的风险。此外，阿片类药物的副作用可能与剂量有关。这项研究将确定预测哪些患者将增加阿片类药物剂量的临床因素。此外，本发明还 我们将研究阿片类药物剂量递增的益处和危害，并预测哪些患者最有可能从这种干预中受益。这项多中心前瞻性队列研究将纳入600名目前正在接受阿片类药物治疗的慢性疼痛患者。将在基线时和每6个月对患者进行一次评价，共24个月。阿片类药物剂量增加的患者（初步数据显示30 - 35%的样本）将在剂量增加后1个月内接受评价，并继续定期6个月随访。本提案的具体目的是：（1）评价哪些患者和临床医生因素可预测阿片类药物剂量增加，（2）确定阿片类药物剂量增加和未增加患者之间疼痛结局和不良反应轨迹的差异，以及（3）评估控制剂量变化后随时间推移与疼痛强度和疼痛相关功能变化相关的因素。我们将确定阿片类药物剂量增加的患者在疼痛强度和功能方面持续改善的程度，以及阿片类药物滥用行为和药物相关不良反应的问题。我们还假设，恐惧回避、疼痛灾难化和自我效能的基线测量将预测哪些患者从阿片类药物剂量增加中获益。这项研究对临床护理具有广泛的意义，提供了新的数据来确定那些最有可能增加阿片类药物剂量的患者，与阿片类药物剂量增加相关的临床医生和机构因素，剂量增加（包括处方阿片类药物滥用）的积极和消极结果的可能性，以及确定患者因素，表明剂量增加最有可能获益。这项研究的长期目标是通过检查增加的效用来改善慢性疼痛的治疗。 阿片类药物剂量在功能和潜在危害方面的变化。

DESCRIPTION (provided by applicant): The use of long-term opioid therapy for chronic non-cancer pain (CNCP) has increased dramatically in recent years. Although chronic opioid therapy is increasingly common, there are marked differences among patients in treatment outcomes. Providers often increase opioid dose during times of worsening pain, which has the potential to decrease pain intensity, but may increase risk of medication-related adverse effects or opioid misuse. Further, side effects of opioid medications may be dose-dependent. This research will identify clinical factors that predict which patients will have increases in opioid doses. Further, we will examine the benefits and harms of opioid dose escalation and predict which patients are most likely to benefit from this intervention. This multi-site prospective cohort study will includ 600 patients with chronic pain who are currently prescribed opioids. Patients will be evaluated at baseline and every six months for 24 total months. Patients who have an increase in opioid dose (preliminary data indicates 30-35% of the sample) will be evaluated within 1 month of their dose increase and continue with regular six month follow-ups. The Specific Aims of this proposal are to: (1) Evaluate which patient and clinician factors predict opioid dose increases, (2) Determine the differences in trajectories of pain outcomes and adverse effects between patients with and without opioid dose increases, and (3) Assess factors associated with changes in pain intensity and pain-related function over time after controlling for dose changes. We will determine the degree to which patients with opioid dose increases have sustained improvement in pain intensity and function, as well as problems with opioid misuse behaviors and medication-related adverse effects. We also hypothesize that baseline measures of fear avoidance, pain catastrophizing, and self-efficacy will predict which patients benefit from increases in opioid dose. This research has broad implications for clinical care, providing novel data to identify those patients most likely to have increases in their opioid doses, clinician and institutional factors associated with opioid dose increases, the likelihood of positive and negativ outcomes from dose increases (including prescription opioid misuse), and identification of patient factors indicating greatest likelihood of benefit from dose increases. The long-term goal of this research is to improve the treatment of chronic pain by examining the utility of increasing opioid doses in terms of changes in function and potential harms.