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

患有慢性疼痛的老年人转向长期使用阿片类药物

• 批准号: 8072997
• 负责人: Michael R Von Korff
• 金额: $ 62.24万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-15 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8072997
• 关键词: Address; Adult; Age; American; Chronic; Chronic Disease; Classification; Clinical; Cohort Studies; Comorbidity; Computerized Medical Record; Data; Development; Dose; Early identification; Elderly; Feeling; Foundations; Functional disorder; Goals; Health Planning; Individual; Individual Differences; Interview; Life; Memory; Mental Depression; Methods; Modeling; Opioid; Outcome; Pain; Pain management; Participant; Patients; Pharmaceutical Preparations; Physicians; Polypharmacy; Prospective Studies; Public Health; Regimen; Reporting; Research; Research Methodology; Risk; Risk Factors; Risk Reduction; Schedule; Therapeutic Studies; Time; Trees; Variant; addiction; chronic pain; drug clearance; experience; follow-up; functional outcomes; high risk; insight; middle age; non-cancer pain; older patient; older women; patient population; psychological outcomes; psychosocial; public health relevance

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

描述（由申请人提供）： 背景和目标 - 近年来，用于慢性非癌性疼痛 (CNCP) 的长期阿片类药物治疗急剧增加，特别是在中老年人中。目前有超过 800 万美国成年人使用阿片类药物来长期治疗 CNCP，但这些患者在疼痛控制和心理社会结果方面存在显着的个体差异。将可能经历良好结果的患者与那些可能患有阿片类药物相关困难和长期阿片类药物治疗产生不利心理社会结果的患者区分开来，现在是一个具有重大临床和公共卫生意义的问题。这项研究将阐明开始慢性阿片类药物治疗的患者的个体风险，为早期识别处于不良心理和功能结果高风险的患者奠定基础。在开始长期使用阿片类药物的中老年人中，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危险因素； 3) 制定实用方法，尽早识别出现不利心理社会结果风险增加的患者。方法——由 1500 名开始长期使用处方阿片类药物的中老年 CNCP 患者组成一个研究队列。数据将通过研究参与者基线访谈以及 3 个月和 12 个月后的随访以及健康计划电子病历数据获得。利用这些数据，拟议的研究将实现以下具体目标： 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。目标 2：确定心理社会功能障碍的危险因素 - 将在开始长期使用阿片类药物的患者中评估一年随访时心理社会功能障碍的危险因素。目标 3：开发临床预测模型 - 将根据基线数据开发一年内心理社会功能障碍的临床预测模型。影响：这项研究将为开始慢性阿片类药物治疗的 CNCP 患者不良心理社会结果的发展和预测提供新的见解。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出可能持续使用阿片类药物的患者以及出现不良心理社会结果的高风险患者。这将为降低这些患者的不良心理和功能结果的风险提供机会。 1 公共卫生相关性：目前有超过 800 万美国成年人使用阿片类药物来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着的个体差异。将可能经历良好结果的患者与那些可能在长期阿片类药物治疗中出现阿片类药物相关困难和不利心理社会结果的患者区分开来，现在是一个具有重大临床和公共卫生意义的问题。这项研究将阐明开始长期阿片类药物治疗的患者的个体风险，为早期识别处于不良心理和功能结果高风险的患者奠定基础。 1