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Restriction of oxycodone in the emergency department (ROXY-ED): A randomised controlled trial. 羟考酮在急诊科的应用限制(ROXY-ED):一项随机对照试验
IF 1.8 Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-01 Epub Date: 2023-07-12 DOI: 10.1177/20494637231189031
Biswadev Mitra, Cristina Roman, Bertha Wu, Carl Luckhoff, Diana Goubrial, Timothy Amos, Holly Bannon-Murphy, Ronald Huynh, Michael Dooley, De Villiers Smit, Peter A Cameron

Background: The prescription of opioids in emergency care has been associated with harm, including overdose and dependence. The aim of this trial was to assess restriction of access to oxycodone (ROXY), in combination with education and guideline modifications, versus education and guideline modifications alone (standard care) to reduce oxycodone administration in the Emergency Department (ED).

Methods: An unblinded, active control, randomised controlled trial was conducted in an adult tertiary ED. Participants were patients aged 18-75 years who had analgesics administered in the ED. The primary intervention was ROXY, through removal of all oxycodone immediate release tablets from the ED imprest, with availability of a small supply after senior clinician approval. The intervention did not restrict prescription of discharge medications. The primary outcome measure was oxycodone administration rates. Secondary outcomes were administration rates of other analgesic medications, time to initial analgesics and oxycodone prescription on discharge.

Results: There were 2258 patients eligible for analysis. Oxycodone was administered to 80 (6.1%) patients in the ROXY group and 221 (23.3%) patients in the standard care group (relative risk (RR) 0.26; 95% CI: 0.21 to 0.33; p < .001). Tapentadol was prescribed more frequently in the ROXY group (RR 2.17; 95% CI: 1.71-2.74), while there were no differences in prescription of other analgesic medications. On discharge, significantly fewer patients were prescribed oxycodone (RR 0.51; 95% CI: 0.39-0.66) and no differences were observed in prescription rates of other analgesic medications. There was no difference in time to first analgesic (HR 0.94; 95% CI: 0.86-1.02).

Conclusions: Restricted access to oxycodone was superior to education and guideline modifications alone for reducing oxycodone use in the ED and reducing discharge prescriptions of oxycodone from the ED. The addition of simple restrictive interventions is recommended to enable rapid changes to clinician behaviour to reduce the potential harm associated with the prescribing of oxycodone in the ED.

背景阿片类药物在急救中的处方与危害有关,包括过量用药和依赖性。本试验的目的是评估结合教育和指导方针修改获得羟考酮(ROXY)的限制,与单独教育和指导原则修改(标准护理)相比,以减少急诊科(ED)的羟考酮给药。方法在一名成人三级ED中进行一项非盲、主动对照、随机对照试验。参与者为年龄在18-75岁之间的患者,他们在ED中服用了止痛药。主要干预措施是ROXY,通过从ED缓冲液中取出所有羟考酮速释片,并在高级临床医生批准后提供少量供应。干预措施并未限制出院药物的处方。主要的疗效指标是羟考酮给药率。次要结果是其他镇痛药物的给药率、首次使用镇痛药的时间和出院时的羟考酮处方。结果2258例患者符合分析条件。ROXY组的80名(6.1%)患者和标准护理组的221名(23.3%)患者服用了羟考酮(相对风险(RR)0.26;95%置信区间:0.21至0.33;p<.001)。ROXY组更频繁地开具他喷他多的处方(RR 2.17;95%CI:1.71-2.74),而其他镇痛药物的处方没有差异。出院时,服用羟考酮的患者明显减少(RR 0.51;95%CI:0.39-0.66),其他镇痛药物的处方率没有差异。首次镇痛的时间没有差异(HR 0.94;95%CI:0.86–1.02)。结论限制使用羟考酮比单独修改教育和指南更能减少ED中羟考酮的使用和减少ED的羟考酮出院处方。建议增加简单的限制性干预措施,以使临床医生的行为能够迅速改变,从而减少与在ED中开羟考酮相关的潜在危害。
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引用次数: 1
Pain with neuropathic characteristics after surgically treated lower limb fractures: Cost analysis and pain medication use. 手术治疗下肢骨折后具有神经性特征的疼痛:成本分析和疼痛药物的使用
IF 1.8 Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-01 Epub Date: 2023-06-15 DOI: 10.1177/20494637231179809
May Ee Png, Matthew L Costa, Stavros Petrou, Juul Achten, Ruth Knight, Julie Bruce, David J Keene

Introduction: Neuropathic pain is prevalent among people after lower limb fracture surgery and is associated with lower health-related quality of life and greater disability. This study estimates the financial cost and pain medication use associated with neuropathic pain in this group.

Methods: A secondary analysis using pain data collected over six postoperative months from participants randomised in the Wound Healing in Surgery for Trauma (WHiST) trial. Pain states were classified as pain-free, chronic non-neuropathic pain (NNP) or chronic neuropathic pain (NP). Cost associated with each pain state from a UK National Health Service (NHS) and personal social services (PSS) perspective were estimated by multivariate models based on multiple imputed data. Pain medication usage was analysed by pain state.

Results: A total of 934 participants who provided either 3- or 6-months pain data were included. Compared to participants with NP, those with NNP (adjusted mean difference -£730, p = 0.38, 95% CI -2368 to 908) or were pain-free (adjusted mean difference -£716, p = 0.53, 95% CI -2929 to 1497) had lower costs from the NHS and PSS perspective in the first three postoperative months. Over the first three postoperative months, almost a third of participants with NP were prescribed opioids and 8% were prescribed NP medications. Similar trends were observed by 6 months postoperatively.

Conclusion: This study found healthcare costs were higher amongst those with chronic NP compared to those who were pain-free or had chronic NNP. Opioids, rather than neuropathic pain medications, were commonly prescribed for NP over the first six postoperative months, contrary to clinical guidelines.

引言神经性疼痛在下肢骨折手术后的人群中普遍存在,与健康相关的生活质量较低和残疾较大有关。这项研究估计了这一群体中与神经性疼痛相关的经济成本和止痛药的使用情况。方法使用从创伤外科手术中的伤口愈合(WHiST)试验中随机抽取的参与者在术后六个月内收集的疼痛数据进行二次分析。疼痛状态分为无痛、慢性非神经性疼痛(NNP)或慢性神经性疼痛。从英国国家医疗服务体系(NHS)和个人社会服务体系(PSS)的角度来看,通过基于多个估算数据的多变量模型估计了与每种疼痛状态相关的成本。根据疼痛状态分析疼痛药物的使用情况。结果共有934名参与者提供了3个月或6个月的疼痛数据。与患有NP的参与者相比,从NHS和PSS的角度来看,患有NNP(调整后的平均差异为730英镑,p=0.38,95%CI−2368至908)或无疼痛(调整后平均差异为716英镑,p=0.53,95%CI–2929至1497)的参与者在术后前三个月的费用较低。在术后的前三个月,近三分之一的NP参与者被开具了阿片类药物处方,8%的参与者被开具NP药物处方。术后6个月观察到类似的趋势。结论本研究发现,与无疼痛或慢性NNP患者相比,慢性NP患者的医疗费用更高。阿片类药物,而不是神经性疼痛药物,通常在术后前六个月用于NP,这与临床指南相反。
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引用次数: 0
Responses to concerns raised about publications don't address the concerns raised. 对对出版物提出的担忧的回应并没有解决所提出的担忧
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-01 Epub Date: 2023-08-29 DOI: 10.1177/20494637231198757
Mark J Bolland, Alison Avenell, Andrew Grey

Recently in the Journal, Amanda Williams described her experience of raising concerns about a group of trials with "untrustworthy data". We were inspired by the work of Williams and colleagues to examine these and other trials by the same research group. Similar to Williams, we found that the patterns of reported data differed from the patterns expected to arise from valid randomisation. We also identified a high proportion of reported baseline p-values for categorial variables that differed from independently calculated p-values. We reported these findings to the affected journals but none of the concerns were addressed and no action will be taken about the majority. Despite the large number of unresolved concerns about these trials, readers will be unaware of the issues, which seems entirely unsatisfactory.

最近,Amanda Williams在《华尔街日报》上描述了她对一组“数据不可信”的试验提出担忧的经历。威廉姆斯及其同事的工作启发了我们,他们研究了同一研究小组的这些试验和其他试验。与Williams类似,我们发现报告数据的模式与有效随机化预期产生的模式不同。我们还发现,分类变量的基线p值与独立计算的p值有很大比例不同。我们向受影响的期刊报告了这些发现,但没有解决任何问题,也不会对大多数问题采取任何行动。尽管这些审判有大量悬而未决的问题,但读者不会意识到这些问题,这似乎完全不令人满意。
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引用次数: 0
The analgesic effect of transmuscular quadratus lumborum block versus erector spinae plane block for women undergoing elective Caesarean section: A randomized controlled trial. 经腰方肌阻滞与竖脊肌平面阻滞对择期剖宫产妇女的镇痛效果:一项随机对照试验
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-01 Epub Date: 2023-06-02 DOI: 10.1177/20494637231181513
Maha Mostafa, Mohamed A Nasr, Maher Fawzy, Aya E Awad, Mohsen M Waheeb

Background: We aimed to compare the analgesic effect and quality of recovery of transmuscular quadratus lumborum block (QLB) and erector spinae plane block (ESPB) in the presence of multimodal analgesia following Caesarean section.

Methods: This randomised controlled trial included full-term pregnant women who underwent elective Caesarean section under spinal anaesthesia without intrathecal morphine. The included women were randomised to receive either bilateral QLB (n = 51) or bilateral thoracic ESPB (n = 51), in addition to the control group (n = 51) who did not receive any block. All participants received regular paracetamol (1 g/6h) and diclofenac (50 mg/8 h). Intravenous morphine was used as a rescue analgesic. The primary outcome was time to first morphine requirement. Secondary outcomes included total postoperative morphine consumption and total Obstetric Quality of Recovery-11 (ObsQoR-11) score.

Results: We analysed 51, 50 and 48 patients in the QLB, ESPB and control groups, respectively. The time to first morphine requirement in both QLB and ESPB groups was longer than that in the control group (median [quartiles] time: 6 [6,12] h, 6 [6,6] h and 4 [3,4] h, respectively; p-value <0.001), without significant differences between the two former groups. The total morphine consumption in both QLB and ESPB groups was lower than that in the control group (median [quartiles]:0 [0,5] mg, 0 [0,5] mg and 25 [25,30] mg, respectively; p-value <0.001), without significant differences between the two former groups. The QLB and ESPB groups had comparable ObsQoR-11 score, and both groups' scores were higher than the control group.

Conclusion: In patients undergoing elective Caesarean section under spinal anaesthesia without intrathecal morphine, both QLB and ESPB provided superior analgesia and quality of recovery compared to the standard care, without significant difference between the two blocks.

背景:我们旨在比较在剖腹产后多模式镇痛的情况下,经血管腰方肌阻滞(QLB)和竖脊肌平面阻滞(ESPB)的镇痛效果和恢复质量。方法这项随机对照试验包括在脊髓麻醉下,在不鞘内注射吗啡的情况下进行选择性剖腹产的足月孕妇。除了未接受任何阻滞的对照组(n=51)外,纳入的女性被随机分配接受双侧QLB(n=51个)或双侧胸部ESPB(n=52个)。所有参与者定期服用扑热息痛(1g/6h)和双氯芬酸(50mg/8h)。静脉注射吗啡被用作抢救性镇痛药。主要结果是第一次需要吗啡的时间。次要结果包括术后吗啡总消耗量和产科总恢复质量-11(ObsQoR-11)评分。结果我们分别分析了QLB组、ESPB组和对照组的51例、50例和48例患者。QLB和ESPB组的首次吗啡需求时间均长于对照组(中位[四分位数]时间:分别为6[6,12]h、6[6,6]h和4[3,4]h;p值<0.001),前两组之间无显著差异。QLB组和ESPB组的吗啡总消耗量均低于对照组(中位[四分位数]:分别为0[0.5]mg、0[0.5]mg和25[25,30]mg;p值<0.001),前两组之间无显著差异。QLB和ESPB组的ObsQoR-11评分相当,两组的评分均高于对照组。结论在没有鞘内吗啡的脊髓麻醉下进行选择性剖腹产的患者中,与标准护理相比,QLB和ESPB都提供了更好的镇痛和恢复质量,两种阻滞之间没有显著差异。
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引用次数: 0
Intersectionality as a theoretical framework for researching health inequities in chronic pain. 交叉性作为研究慢性疼痛健康不平等的理论框架
IF 1.8 Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-01 Epub Date: 2023-07-09 DOI: 10.1177/20494637231188583
Cassandra Macgregor, Jackie Walumbe, Emmanuelle Tulle, Christopher Seenan, David N Blane

Chronic pain is experienced unequally by different population groups; we outline examples from the pain literature of inequities related to gender, ethnicity, socioeconomic and migration status. Health inequities are systematic, avoidable and unfair differences in health outcomes between groups of people, with the fundamental 'causes of causes' recognised as unequal distribution of income, power and wealth. Intersectionality can add further theory to health inequities literature; collective social identities including class/socioeconomic status, race/ethnicity, gender, migration status, age, sexuality and disabled status intersect in multiple interconnected systems of power leading to differing experiences of privilege and oppression which can be understood as axes of health inequities. The process of knowledge creation in pain research is shaped by these interconnected systems of power, and may perpetuate inequities in pain care as it is largely based on majority white, middle class, Eurocentric populations. Intersectionality can inform research epistemology (ways of knowing), priorities, methodology and methods. We give examples from the literature where intersectionality has informed a justice oriented approach across different research methods and we offer suggestions for further development. The use of a reductionist frame can force unachievable objectivity on to complex health concepts, and we note increasing realisation in the field of the need to understand the individuals within their social world, and recognise the fluid and contextual nature of this.

不同人群对慢性疼痛的体验是不平等的;我们概述了与性别、种族、社会经济和移民身份有关的不平等的痛苦文献中的例子。卫生不平等是指不同人群之间在卫生结果方面存在系统性、可避免和不公平的差异,其根本的“原因之因”被认为是收入、权力和财富的不平等分配。交叉性可以为卫生不平等文献增加进一步的理论;集体社会身份,包括阶级/社会经济地位、种族/民族、性别、移民身份、年龄、性取向和残疾状况,在多个相互关联的权力系统中相互交叉,导致特权和压迫的不同经历,这些经历可以被理解为卫生不平等的轴线。疼痛研究中的知识创造过程是由这些相互关联的权力系统塑造的,并且可能使疼痛护理中的不平等永久化,因为它主要基于大多数白人,中产阶级,以欧洲为中心的人口。交叉性可以为研究认识论(认识的方式)、优先级、方法论和方法提供信息。我们从文献中给出了一些例子,其中交叉性在不同的研究方法中为正义导向的方法提供了信息,并为进一步发展提供了建议。使用还原主义框架可能会将无法实现的客观性强加于复杂的健康概念上,我们注意到,该领域越来越多地认识到,需要了解其社会世界中的个人,并认识到这种情况的流动性和情境性。
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引用次数: 0
Behaviour change in clinicians: When the triple tell'em don't work. 临床医生的行为变化:当三重信号不起作用时
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-01 Epub Date: 2023-09-07 DOI: 10.1177/20494637231201716
Roxaneh Zarnegar
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引用次数: 0
The effectiveness of progressive muscle relaxation technique in reducing cancer-related pain among palliative care patients: A randomized controlled trial. 渐进式肌肉放松技术在减轻姑息治疗患者癌症相关疼痛中的有效性:一项随机对照试验
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2023-10-01 Epub Date: 2023-07-18 DOI: 10.1177/20494637231190191
Huda Anshasi, Mohammad Saleh, Maysoon S Abdalrahim, Omar Shamieh

Purpose: Cancer-related pain (CRP) is a common and distressing symptom experienced by many patients receiving palliative care. The purpose of this trial was to evaluate the effectiveness of the progressive muscle relaxation (PMR) technique in reducing CRP in patients receiving palliative care.

Methods: A total of 148 patients diagnosed with cancer and receiving palliative care were randomly allocated to either an intervention or control group. The intervention group received a 4-week daily course of PMR technique, while the control group received only usual care. Data was collected using a demographic and clinical characteristics form, as well as the Brief Pain Inventory (BPI). Blind evaluations were conducted prior to the start of the intervention (T0), at the end of the 4-week PMR intervention (T1), and at 1-month follow-up (T2).

Results: The results of this trial demonstrated a significant decrease in pain intensity scores for the PMR group compared to the control group at both T1 and T2 (p < 0.05). Furthermore, the PMR group also exhibited significant improvements in pain interference with general activity, mood, relations with others, sleep, and enjoyment of life scores compared to the control group at both T1 and T2 (p < 0.05).

Conclusion: The results of this trial suggest that the PMR technique may be an effective intervention for reducing pain intensity and improving pain interference with life activities in cancer patients receiving palliative care. However, further research is needed to provide more robust evidence for the effectiveness of this intervention.Clinical trial registration number: NCT04436705. Registered at ClinicalTrials.gov.

目的癌症相关疼痛(CRP)是许多接受姑息治疗的患者所经历的一种常见而痛苦的症状。本试验的目的是评估渐进性肌肉松弛(PMR)技术在接受姑息治疗的患者中降低CRP的有效性。方法将148例诊断为癌症并接受姑息治疗的患者随机分为干预组或对照组。干预组每天接受4周的PMR技术疗程,而对照组只接受常规护理。使用人口统计学和临床特征表以及简要疼痛清单(BPI)收集数据。在干预开始前(T0)、4周PMR干预结束时(T1)和1个月随访时(T2)进行盲评估。结果该试验的结果表明,与对照组相比,PMR组在T1和T2时的疼痛强度得分显著降低(p<0.05)。此外,PMR小组在疼痛对一般活动、情绪、与他人的关系、睡眠、,结论本试验结果提示,PMR技术可能是减轻癌症患者疼痛强度、改善疼痛对生活活动干扰的有效干预措施。然而,还需要进一步的研究来为这种干预的有效性提供更有力的证据。临床试验注册号:NCT04436705。在ClinicalTrials.gov注册
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引用次数: 0
Pain and diet: A summary of the evidence for the role of diet modification in chronic pain 疼痛和饮食:饮食改变在慢性疼痛中的作用的证据总结
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-30 DOI: 10.1177/20494637231203856
David Cameron, Joanna Harrison, Shiva Tripathi, James Edward Hill
Chronic pain constitutes a significant burden to patients and healthcare systems. For many patients, the only option is to attempt to manage their pain within their daily lives. Here, we review evidence provided by three systematic reviews for the effect of diet and diet supplements on patients’ experience of chronic pain.
慢性疼痛对患者和卫生保健系统构成了重大负担。对许多病人来说,唯一的选择就是在日常生活中控制疼痛。在这里,我们回顾了三篇关于饮食和饮食补充剂对慢性疼痛患者体验的影响的系统综述提供的证据。
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引用次数: 0
Evaluating the feasibility of delivering a pain management programme for adults living with sickle cell disease 评估镰状细胞病成人患者疼痛管理方案的可行性
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-21 DOI: 10.1177/20494637231202744
Rebecca McLoughlin, Jenna Love, Jared G Smith, Whitney Scott, Tim Noblet
Background Pain is the prominent feature of sickle cell disease (SCD) and negatively affects quality of life. Delivery of pain management programmes (PMPs) has been suggested in clinical guidelines for pain management in SCD; however, further evidence of the feasibility and effectiveness of PMPs in this population is needed. This study explored the feasibility of delivering a sickle cell pain management programme (SCPMP) for adults within a haemoglobinopathies service. Methods A single arm, repeated-measures observational design was used to determine feasibility of delivering the SCPMP at one study site. Primary feasibility outcomes were recruitment, completion of treatment and outcome measures, satisfaction, credibility and acceptability to participants. Secondary feasibility outcomes were treatment outcomes and processes, frequency of vaso-occlusive crisis (VOC) and healthcare utilisation. Results Four of five feasibility criteria were met. Annual recruitment of eight participants to a SCPMP was not achieved. Twenty-nine people began a SCPMP during the study period. Twenty-five (86.2%) participants attended ≥5/8 sessions and 21(84%) programme completers provided all end of programme questionnaires. Mean scores of >7 on ten-point scales were seen across satisfaction and credibility questions. At least moderate (Hedges g >0.5) effect sizes were seen in pre-post SCPMP measures of pain interference, anxiety, depression, self-efficacy, pain-related worry and acceptance. A small (Hedges g 0.4) effect size was seen in HRQoL. Following SCPMP attendance, mean frequency of self-reported VOC and hospital admissions reduced. Conclusions This study suggests that, given an adequate source of referrals, a SCPMP is feasible to deliver and appears acceptable and credible to participants. Exploration of influences on recruitment, such as barriers to group interventions, would be illuminating, prior to investigating feasibility of an adequately powered randomised-controlled trial.
疼痛是镰状细胞病(SCD)的显著特征,并对生活质量产生负面影响。疼痛管理方案(pmp)的交付已被建议在SCD疼痛管理的临床指南;然而,需要进一步证明PMPs在这一人群中的可行性和有效性。本研究探讨了在血红蛋白病服务中为成人提供镰状细胞疼痛管理方案(SCPMP)的可行性。方法采用单臂、重复测量观察设计来确定在一个研究地点递送SCPMP的可行性。主要可行性结果包括招募、治疗完成和结果测量、满意度、可信度和参与者的可接受性。次要可行性结果是治疗结果和过程、血管闭塞危象(VOC)的频率和医疗保健利用。结果符合5项可行性标准中的4项。没有实现每年为方案管理方案征聘8名参与者。在研究期间,29人开始了SCPMP。25名(86.2%)参与者参加了≥5/8次会议,21名(84%)项目完成者提供了所有项目结束时的问卷。满意度和可信度问题的平均得分为7分(满分为10分)。在SCPMP前后对疼痛干扰、焦虑、抑郁、自我效能、疼痛相关担忧和接受的测量中,至少可以看到中等(Hedges g >0.5)的效应量。HRQoL的效应值较小(Hedges g 0.4)。参加SCPMP后,自我报告VOC的平均频率和住院次数减少。结论:本研究表明,如果有足够的转诊来源,SCPMP是可行的,并且对参与者来说是可接受和可信的。在调查充分有力的随机对照试验的可行性之前,探索对招募的影响,如群体干预的障碍,将具有启发性。
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引用次数: 0
Is post-traumatic stress disorder a risk factor for development of opioid use disorder among individuals with chronic non-cancer pain? A systematic review 创伤后应激障碍是慢性非癌性疼痛患者发生阿片类药物使用障碍的危险因素吗?系统回顾
Q4 CLINICAL NEUROLOGY Pub Date : 2023-09-20 DOI: 10.1177/20494637231202078
Arvind Kendurkar, Jack Wilson, Matthew Sunderland, Adrian Dunlop, Chris Hayes, Christina Marel, Katherine L Mills
Introduction There is emerging evidence that posttraumatic-stress disorder may have mediating effects in development of chronic-non-cancer-pain and opioid-use-disorder independently, but its impact on the development of opioid-use-disorder in people with chronic-non-cancer pain is still unclear. Objectives (i) Estimate the risk of opioid-use-disorder among individuals with chronic-non-cancer-pain and posttraumatic-stress disorder, relative to those with chronic-non-cancer-pain only, and (ii) identify potential correlates of opioid-use-disorder among people with chronic-non-cancer-pain and posttraumatic-stress disorder. Methods This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Longitudinal, epidemiological, cohort, follow-up, retrospective, prospective and cross-sectional studies reporting measures of variance on the likelihood of developing opioid-use-disorder with posttraumatic-stress disorder among individuals with chronic-non-cancer-pain were identified from six-electronic databases (Medline, Embase, Evidence-based Medicine reviews, PsycINFO, Scopus and Web of Science) until December 2022. Results Three out of the four studies, which met the selection criteria for this analysis reported statistically significant positive association between risk of developing opioid-use-disorder with posttraumatic-stress disorder among chronic-non-cancer-pain cohort (unadjusted Relative-Risk range: 1.51–5.27) but this association was not evident in the fourth study (adjusted Relative-Risk: 0.96; statistically non-significant), when adjusted for sociodemographic variables. The increased risk was noted particularly with females and chronic musculoskeletal pain conditions. Conclusions Posttraumatic-stress disorder can increase the risk of development of opioid-use-disorder among people with chronic-non-cancer-pain and a better understanding of this relationship will help to predict and prevent the development of opioid-use-disorder and may also help in reducing the disability and burden associated with chronic-non-cancer-pain. Perspective This review quantifies the risk of developing opioid-use-disorder in the context of posttraumatic-stress disorder among individuals with chronic-non-cancer-pain. Awareness and subsequent practice change will reduce the increasing global burden associated with the chronic-non-cancer-pain.
越来越多的证据表明,创伤后应激障碍可能在慢性非癌性疼痛和阿片类药物使用障碍的发展中具有独立的中介作用,但其对慢性非癌性疼痛患者阿片类药物使用障碍的影响尚不清楚。(i)相对于仅患有慢性非癌症性疼痛和创伤后应激障碍的患者,估计慢性非癌症性疼痛和创伤后应激障碍患者中阿片类药物使用障碍的风险;(ii)确定慢性非癌症性疼痛和创伤后应激障碍患者中阿片类药物使用障碍的潜在相关性。方法本系统评价按照系统评价和荟萃分析指南的首选报告项目进行。从六个电子数据库(Medline、Embase、循证医学评论、PsycINFO、Scopus和Web of Science)中确定了截至2022年12月的纵向、流行病学、队列、随访、回顾性、前瞻性和横断面研究,报告了慢性非癌性疼痛患者发生阿片类药物使用障碍合并创伤后应激障碍可能性的方差测量。结果符合本分析选择标准的4项研究中有3项报告慢性非癌性疼痛队列中发生阿片类药物使用障碍与创伤后应激障碍的风险存在统计学显著正相关(未调整相对风险范围:1.51-5.27),但在第4项研究中这种关联不明显(调整相对风险:0.96;统计上不显著),当调整了社会人口变量。这种风险的增加在女性和慢性肌肉骨骼疼痛患者中尤为明显。结论创伤后应激障碍可增加慢性非癌性疼痛患者发生阿片类药物使用障碍的风险,更好地了解这一关系将有助于预测和预防阿片类药物使用障碍的发生,并有助于减少与慢性非癌性疼痛相关的残疾和负担。本综述量化了慢性非癌性疼痛患者在创伤后应激障碍背景下发生阿片类药物使用障碍的风险。认识和随后的实践改变将减轻与慢性非癌性疼痛相关的日益增加的全球负担。
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British Journal of Pain
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