Trajectories of opioid use among patients with low back pain: Association to work absence.

IF 3.5 2区 医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-08-02 DOI:10.1002/ejp.4706
Johan Liseth Hansen, Knut Reidar Wangen
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Abstract

Background: Low back pain (LBP) is a leading reason for opioid use and a closer examination of opioid use and productivity losses among these patients is needed. We identify opioid use trajectories using a group-based trajectory model (GBTM) and estimate productivity losses across the trajectories.

Methods: Patients diagnosed with LBP in Swedish specialty care between 2011 and 2015, between the ages of 20 and 60, were included. Two GBTMs were estimated on monthly opioid use (converted to oral morphine equivalents) during the two 12-month periods preceding and following diagnosis. Productivity losses were estimated using the human-capital approach.

Results: In total, 147,035 patients were included. The mean age at diagnosis was 43 years of age and 49% of the patients were male. A qualitative assessment of the identified groups in the GBTM models was made based on the patterns of opioid use. We chose three pre-diagnosis groups characterized as 'Pre-low' (N = 109,492), 'Pre-increase' (N = 27,336) and 'Pre-high' (N = 10,207). Similarly, four post-diagnosis groups were chosen and characterized as 'Post-low' (N = 73,287), 'Post-decrease' (N = 39,446), 'Post-moderate' (N = 20,001) and 'Post-high' (N = 13,595). Only 50% of the patients in the 'Pre-high' group were in the 'Post-high' group. The total productivity losses by the pre-diagnosis groups were more than 2.7 billion Euros over the total 6-year study period.

Conclusion: This study highlights how patients with LBP and high use of opioids are highly correlated before and after diagnosis. Patients with high use of opioids also exhibit high work absence and productivity losses.

Significance statement: This was the first study to estimate trajectories of opioids in the two time periods before and after a diagnosis of low back pain. For the first time, productivity losses were also estimated across the identified opioid use trajectories.

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腰痛患者使用阿片类药物的轨迹:与缺勤的关系
背景:腰背痛(LBP)是使用阿片类药物的一个主要原因,需要对这些患者使用阿片类药物和生产力损失进行更深入的研究。我们利用基于群体的轨迹模型(GBTM)确定了阿片类药物的使用轨迹,并估算了不同轨迹下的生产力损失:方法:纳入 2011 年至 2015 年期间在瑞典专科医疗机构确诊为腰椎间盘突出症的患者,年龄在 20 岁至 60 岁之间。根据诊断前后两个 12 个月期间每月阿片类药物使用量(转换为口服吗啡当量)估算出两个 GBTM。采用人力资本法对生产力损失进行了估算:共纳入 147,035 名患者。确诊时的平均年龄为 43 岁,49% 的患者为男性。根据阿片类药物的使用模式,对 GBTM 模型中确定的群体进行了定性评估。我们选择了三个诊断前组别,分别为 "低剂量前"(109,492 人)、"增加前"(27,336 人)和 "高剂量前"(10,207 人)。同样,还选择了四个诊断后组别,分别为 "低诊断后"(73,287 人)、"低诊断后"(39,446 人)、"中诊断后"(20,001 人)和 "高诊断后"(13,595 人)。在 "预高 "组中,只有 50% 的患者属于 "后高 "组。在长达 6 年的研究期间,诊断前组的生产力损失总额超过 27 亿欧元:本研究强调了枸杞多糖症患者和阿片类药物高用量患者在确诊前后的高度相关性。大量使用阿片类药物的患者也表现出较高的缺勤率和生产率损失:这是首次对腰背痛确诊前后两个时间段内阿片类药物的使用轨迹进行估算的研究。该研究还首次对已确定的阿片类药物使用轨迹进行了生产力损失估计。
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来源期刊
European Journal of Pain
European Journal of Pain 医学-临床神经学
CiteScore
7.50
自引率
5.60%
发文量
163
审稿时长
4-8 weeks
期刊介绍: European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.
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