Cognitive Function During Opioid Tapering in Patients with Chronic Pain: A Prospective Cohort Study.
Cognitive Function During Opioid Tapering in Patients with Chronic Pain: A Prospective Cohort Study.
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DOI：
10.2147/jpr.s273025
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发表时间：
2020
影响因子：
2.7
通讯作者：
Estrup S
中科院分区：
文献类型：
--
作者：
Laigaard J;Bache N;Stottmeier S;Mathiesen O;Estrup S
长期阿片类药物治疗慢性非癌性疼痛和不良反应（包括对认知功能和生活质量的影响）的有效性和安全性缺乏证据，值得关注。我们的目的是研究阿片类药物减少期间慢性非癌性疼痛患者的认知功能和健康相关生活质量。在两个多学科疼痛中心，所有计划减少阿片类药物的患者都进行了资格筛选。认知功能采用神经心理状态评估可重复测试（rban）和试验测试A和b进行评估。健康相关生活质量采用短表格36 （SF36）和医院焦虑抑郁量表（HADS）进行评估。我们纳入了51名参与者，40名参与者参加了中位254 （IQR 106-357）天的随访。基线rban评分为82分（IQR 65-93），参考人群常模值为100 （SD±15）。每日阿片类药物消耗量从中位数80 （IQR 45-161）口服吗啡毫克当量减少到19 （IQR 0-60）毫克。rban评分估计值在逐渐减少后增加6.2分（95% CI 3.1-9.3, p=0.0004）。在试验时间、HADS或SF36评分方面没有观察到差异。一般来说，认知功能在阿片类药物逐渐减少后表现出轻微的改善，与健康相关的生活质量、抑郁和焦虑评分稳定。临床意义尚不清楚，因为rban评分没有最小的临床重要差异。
Evidence for efficacy and safety lacks for long-term opioid therapy in patients with chronic non-cancer pain and adverse effects, including affection of cognitive function and quality of life, is of concern. We aimed to investigate cognitive function and health-related quality of life in patients with chronic non-cancer pain during opioid reduction. At two multidisciplinary pain centers, all patients with planned opioid reduction were screened for eligibility. Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Trail Making Test A and B. Health-related quality of life was assessed using Short Form-36 (SF36) and Hospital Anxiety and Depression Scale (HADS). We included 51 participants and 40 participants attended follow-up of median 254 (IQR 106–357) days. Baseline RBANS score was 82 (IQR 65–93) with reference population norm value of 100 (SD±15). Daily opioid consumption was reduced from median 80 (IQR 45–161) oral morphine milligram equivalents to 19 (IQR 0–60) mg. RBANS score estimate increased by 6.2 (95% CI 3.1–9.3, p=0.0004) points after tapering. No differences were observed for Trail Making Test times, HADS or SF36 scores. Generally, cognitive function showed minor improvement after opioid tapering with stationary health-related quality of life, depression and anxiety scores. The clinical significance is unclear, as no minimal clinically important difference in RBANS score is available.