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大幅增加，特别是在中老年人中。现在有800多万美国成年人使用阿片类药物进行CNCP的长期治疗，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。在慢性阿片类药物治疗中，区分可能经历良好结果的患者与那些可能有阿片类药物相关困难和不良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。这项研究将澄清启动慢性阿片类药物治疗的患者的个体风险，为及早识别具有不良心理和功能结果的高风险患者奠定基础。在开始长期使用阿片类药物的中老年人中，这项研究将：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，早期识别具有不良心理社会结果风险的患者。方法--由1500名中老年CNCP患者组成研究队列，开始长期使用处方阿片类药物。数据将通过研究参与者在基线以及3个月和12个月后的随访中获得，并从健康计划电子医疗记录数据中获得。利用这些数据，拟议的研究将涉及以下具体目标：目标1：确定长期使用阿片类药物的预测因素--将评估基线变量，以确定一年内持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。目的2：确定心理社会功能障碍的危险因素-将在一年的随访中评估开始长期使用阿片类药物的患者的心理社会功能障碍的风险因素。目标3：开发临床预测模型--心理社会功能障碍的临床预测模型将从基线数据开发出来。影响：这项研究将对启动慢性阿片类药物治疗的CNCP患者的不良心理社会结局的发展和预测产生新的见解。这项研究将帮助执业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的高风险患者。这将提供机会，以减少这些患者的不良心理和功能后果的风险。1 公共卫生相关性：现在有800多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很大的个体差异。在慢性阿片类药物治疗中，区分那些可能经历良好结果的患者与那些可能有阿片类药物相关困难和不良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。这项研究将澄清启动慢性阿片类药物治疗的患者的个体风险，为及早识别具有不良心理和功能结果的高风险患者奠定基础。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