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

描述（由申请人提供）：背景和目标-近年来，慢性非癌症疼痛（CNCP）的长期阿片类药物治疗急剧增加，特别是在中年和老年人中。超过800万美国成年人现在使用阿片类药物长期管理CNCP，但这些患者在疼痛控制和心理社会结果方面存在显著的个体差异。区分可能经历有利结果的患者与可能患有阿片类药物相关困难和慢性阿片类药物治疗不利心理社会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。这项研究将阐明启动慢性阿片类药物治疗的患者的个体风险，为早期识别具有不良心理和功能结局高风险的患者奠定基础。在开始长期使用阿片类药物的中年和老年人中，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风险因素; 3）开发实用方法，用于早期识别不良心理社会结果风险增加的患者。方法-一个研究队列将形成1500中年和老年CNCP患者开始长期使用处方阿片类药物。将通过基线时和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数据。使用这些数据，拟议的研究将解决以下具体目标：目标1：确定长期阿片类药物使用的预测因素-将评估基线变量，以确定一年内继续使用阿片类药物的预测因素，并了解影响持续使用的因素。目标二：识别心理社会功能障碍的风险因素-将在开始长期使用阿片类药物的患者中评价1年随访时心理社会功能障碍的风险因素。目标3：开发临床预测模型-将根据基线数据开发一年时心理社会功能障碍的临床预测模型。影响：这项研究将产生新的见解，发展和预测CNCP患者开始慢性阿片类药物治疗的不利心理社会结果。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良心理社会后果高风险的患者。这将为降低这些患者不良心理和功能结局的风险提供机会。1 公共卫生相关性：目前，超过800万美国成年人使用阿片类药物长期治疗慢性非癌症疼痛，但这些患者在疼痛控制和心理社会结果方面存在显著的个体差异。区分可能经历有利结果的患者与那些可能具有阿片类药物相关困难和慢性阿片类药物治疗不利心理社会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。这项研究将阐明启动慢性阿片类药物治疗的患者的个体风险，为早期识别具有不良心理和功能结局高风险的患者奠定基础。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