Long-term Opioid Management of Chronic Pain: Trends and Risks

慢性疼痛的长期阿片类药物治疗：趋势和风险

• 批准号: 7292657
• 负责人: Michael R Von Korff
• 金额: $ 55.17万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-30 至 2010-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7292657
• 关键词: Adult; Adverse event; Affect; Alcohol abuse; American; Back Pain; Behavioral; California; Caring; Case-Control Studies; Characteristics; Chronic; Chronic Disease; Clinical; Cohort Studies; Condition; Data; Diagnosis; Drug abuse; Epidemiologic Methods; Exposure to; Goals; Health; Health Planning; Health Services Research; Healthcare; Hospitalization; Individual; Knowledge; Long-Term Effects; Medical Records; Medicine; Methods; Mood Disorders; Non-Malignant; Opioid; Opioid Analgesics; Overdose; Pain; Paper; Patients; Persons; Pharmaceutical Preparations; Population; Prevalence; Probability; Provider; Recording of previous events; Relative (related person); Relative Risks; Research; Research Design; Research Personnel; Risk; Risk Factors; Schedule; Substance abuse problem; Testing; Therapeutic Studies; Tracer; Treatment Protocols; Visit; abstracting; case control; chronic pain; cohort; day; experience; mortality; opioid abuse; prescription document; prescription procedure; trend

DESCRIPTION (provided by applicant): Several million Americans receive long-term opioid therapy for chronic non-malignant pain. Little is known about the determinants and risks of this treatment regimen. This research focuses on back pain as a tracer condition. Health services research and epidemiologic methods will be used to understand who receives long-term opioid therapy and to assess associated risks including onset of opioid abuse and mortality. This research will be conducted in two large, non-profit health plans serving over 1% of the U.S. population. Research goals - Our goals are to advance knowledge concerning determinants and risks of long-term opioid therapy among chronic pain patients. Aim 1-Examine trends: We will describe trends in use of long-term opioid therapy in the participating health plans from 1995-2006 and determine how patient characteristics indicating clinical complexity and prior substance abuse are related to trends in long-term opioid use. Aim 2-Assess risks of opioid abuse: We will assess risk factors for opioid abuse among persons receiving long-term opioid therapy. Primary hypotheses are: 1) Among persons receiving long-term opioid therapy for back pain, use of long-acting opioids is associated with reduced risks of onset of opioid abuse and misuse relative to long-term use of short-acting opioids. 2) A prior history of drug abuse will increase risks of opioid abuse and misuse among those receiving long-term opioid therapy for back pain. These hypotheses will be tested through a case-control study comparing recent onset cases to controls (N=600). Aim 3-Assess mortality and other adverse event risks: We will assess whether mortality and other adverse event risks are increased by long-term opioid therapy. Primary hypotheses are: 1) Long-term use of opioids for back pain will be associated with increased mortality. 2) Long-term use of long-acting opioids will increase mortality risk relative to long-term use of short-acting opioids. 3) A prior history of substance abuse will be associated with increased mortality among persons receiving long-term opioid therapy. We will evaluate these hypotheses through a case-cohort study (N=1600). We will extend these analyses by studying the effects of long-term opioid therapy on other adverse events including: all-cause and opioid-related hospitalization; opioid overdose; and onset of recognized mood disorder.

描述（由申请人提供）：数百万美国人接受长期阿片类药物治疗慢性非恶性疼痛。人们对这种治疗方案的决定因素和风险知之甚少。这项研究的重点是将背痛作为一种示踪病症。卫生服务研究和流行病学方法将用于了解谁接受长期阿片类药物治疗，并评估相关风险，包括阿片类药物滥用的发生和死亡率。这项研究将在两个大型非营利性健康计划中进行，服务于超过 1% 的美国人口。研究目标 - 我们的目标是增进对慢性疼痛患者长期阿片类药物治疗的决定因素和风险的了解。目标 1 - 检查趋势：我们将描述 1995 年至 2006 年参与的健康计划中长期阿片类药物治疗的使用趋势，并确定表明临床复杂性和既往药物滥用的患者特征与长期阿片类药物使用趋势的关系。目标 2 - 评估阿片类药物滥用的风险：我们将评估接受长期阿片类药物治疗的人滥用阿片类药物的风险因素。主要假设是：1）在接受长期阿片类药物治疗背痛的人中，相对于长期使用短效阿片类药物，使用长效阿片类药物可降低阿片类药物滥用和误用的风险。 2) 既往药物滥用史会增加长期接受阿片类药物治疗背痛的患者滥用阿片类药物和误用的风险。这些假设将通过病例对照研究进行检验，该研究将近期发病病例与对照病例进行比较（N=600）。目标 3 - 评估死亡率和其他不良事件风险：我们将评估长期阿片类药物治疗是否会增加死亡率和其他不良事件风险。主要假设是：1）长期使用阿片类药物治疗背痛会导致死亡率增加。 2）相对于长期使用短效阿片类药物，长期使用长效阿片类药物会增加死亡风险。 3) 既往药物滥用史与接受长期阿片类药物治疗的患者死亡率增加有关。我们将通过病例队列研究 (N=1600) 评估这些假设。我们将通过研究长期阿片类药物治疗对其他不良事件的影响来扩展这些分析，包括：全因和阿片类药物相关的住院治疗；阿片类药物过量；以及公认的情绪障碍的发作。