Association of Long-term Opioid Therapy With Functional Status, Adverse Outcomes, and Mortality Among Patients With Polyneuropathy
Association of Long-term Opioid Therapy With Functional Status, Adverse Outcomes, and Mortality Among Patients With Polyneuropathy
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DOI：
10.1001/jamaneurol.2017.0486
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发表时间：
2017-07-01
期刊：
影响因子：
29
通讯作者：
Klein, Christopher J.
中科院分区：
文献类型：
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作者：
Hoffman, E. Matthew;Watson, James C.;Klein, Christopher J.
重要性 多发性神经病是普通诊所和专科诊所治疗的最常见的疼痛病症之一。神经性疼痛经常导致决定使用长期阿片类药物治疗。了解多发性神经病患者长期使用阿片类药物与功能状态、不良后果和死亡率之间的关系可能会影响有关阿片类药物治疗的特定疾病决策。 目的 量化多发性神经病患者中长期使用阿片类药物的患病率，并评估长期使用阿片类药物与功能状态、不良结果和死亡率之间的关系。 设计、设置和参与者 队列研究对 2006 年 1 月 1 日至 2010 年 12 月 31 日期间给予多发性神经病患者和门诊对照患者的处方进行了研究，以确定长期使用阿片类药物的情况以及其他结果。最近一次随访截至 2016 年 11 月 25 日。 暴露 长期阿片类药物治疗，定义为 1 个或多个连续阿片类药物处方导致连续 90 天或更长时间使用阿片类药物。 主要结果和措施 多发性神经病患者和对照患者中长期阿片类药物治疗的患病率。对接受长期阿片类药物治疗（≥ 90 天）的多发性神经病患者和接受较短时间阿片类药物治疗的多发性神经病患者进行患者报告的功能状态、记录的不良结果和死亡率进行比较。 结果 在 2892 名多发性神经病患者（1364 名女性和 1528 名男性；平均 [SD] 年龄，67.5 [16.6] 岁）和 14 名多发性神经病患者中， 在 435 名对照者（6827 名女性和 7608 名男性；平均 [SD] 年龄，67.5 [16.5] 岁）中，多发性神经病患者比对照者更频繁地接受长期阿片类药物治疗（545 [18.8%] vs 780 [5.4%]）。长期接受阿片类药物治疗的多发性神经病患者的多种功能状态标志物即使在调整医疗合并症后也略有较差，包括对步态辅助工具的依赖增加（调整后的比值比，1.9；95% CI，1.4-2.6）；长期使用阿片类药物并未改善功能状态标志物。长期接受阿片类药物治疗的多发性神经病患者中，不良结果更为常见，包括抑郁症（调整后风险比，1.53；95% CI，1.29-1.82）、阿片类药物依赖（调整后风险比，2.85；95% CI，1.54-5.47）和阿片类药物过量（调整后风险比，5.12；95% CI， 1.63-19.62).结论和相关性多发性神经病增加了长期阿片类药物治疗的可能性。不能排除慢性疼痛本身是接受长期阿片类药物治疗的患者功能状态恶化的一个原因。然而，长期阿片类药物治疗并不能改善功能状态，反而会增加随后阿片类药物依赖和过量服用的风险。
IMPORTANCE Polyneuropathy is one of the most common painful conditions managed within general and specialty clinics. Neuropathic pain frequently leads to decisions about using long-term opioid therapy. Understanding the association of long-term opioid use with functional status, adverse outcomes, and mortality among patients with polyneuropathy could influence disease-specific decisions about opioid treatment.OBJECTIVES To quantify the prevalence of long-term opioid use among patients with polyneuropathy and to assess the association of long-term opioid use with functional status, adverse outcomes, and mortality.DESIGN, SETTING, AND PARTICIPANTS A retrospective population-based cohort study was conducted of prescriptions given to patients with polyneuropathy and to controls in ambulatory practice between January 1, 2006, and December 31, 2010, to determine exposure to long-term opioid use as well as other outcomes. The latest follow-up was conducted through November 25, 2016.EXPOSURES Long-term opioid therapy, defined by 1 or multiple consecutive opioid prescriptions resulting in 90 continuous days or more of opioid use.MAIN OUTCOMES AND MEASURES Prevalence of long-term opioid therapy among patients with polyneuropathy and controls. Patient-reported functional status, documented adverse outcomes, and mortality were compared between patients with polyneuropathy receiving long-term opioid therapy (>= 90 days) and patients with polyneuropathy receiving shorter durations of opioid therapy.RESULTS Among the 2892 patients with polyneuropathy (1364 women and 1528 men; mean [SD] age, 67.5 [16.6] years) and the 14 435 controls (6827 women and 7608 men; mean [SD] age, 67.5 [16.5] years), patients with polyneuropathy received long-term opioids more often than did controls (545 [18.8%] vs 780 [5.4%]). Patients with polyneuropathy who were receiving long-term opioids had multiple functional status markers that were modestly poorer even after adjusting for medical comorbidity, including increased reliance on gait aids (adjusted odds ratio, 1.9; 95% CI, 1.4-2.6); no functional status markers were improved by long-term use of opioids. Adverse outcomes were more common among patients with polyneuropathy receiving long-term opioids, including depression (adjusted hazard ratio, 1.53; 95% CI, 1.29-1.82), opioid dependence (adjusted hazard ratio, 2.85; 95% CI, 1.54-5.47), and opioid overdose (adjusted hazard ratio, 5.12; 95% CI, 1.63-19.62).CONCLUSIONS AND RELEVANCE Polyneuropathy increased the likelihood of long-term opioid therapy. Chronic pain itself cannot be ruled out as a source of worsened functional status among patients receiving long-term opioid therapy. However, long-term opioid therapy did not improve functional status but rather was associated with a higher risk of subsequent opioid dependency and overdose.