当前位置： SCI文献检索 > JOURNAL OF GENERAL INTERNAL MEDICINE期刊下所有文献 > Association Between Opioid Dose Reduction Against Patients' Wishes and Change in Pain Severity.

Association Between Opioid Dose Reduction Against Patients' Wishes and Change in Pain Severity.

Abstract：

BACKGROUND:There is inadequate evidence of long-term benefit from opioid medications for chronic pain and substantial evidence of potential harms. For patients, dose reduction may be beneficial when implemented voluntarily and supported by a multidisciplinary team but experts have advised against involuntary opioid reduction. OBJECTIVES:To assess the prevalence of self-reported involuntary opioid reduction and to examine whether involuntary opioid reduction is associated with changes in pain severity. DESIGN:Prospective observational cohort study. PARTICIPANTS:Primary care patients treated with long-term opioid therapy in the Veterans Health Administration (N = 290). MAIN MEASURES:The primary exposure was self-reported past year involuntary opioid reduction. The primary outcome was the three-item PEG scale, which measures past-week average pain intensity and interference with enjoyment of life and general activity. KEY RESULTS:Past year opioid reduction or discontinuation was reported by 63% (184/290). Similar numbers reported involuntary (88/290) and voluntary (96/290) opioid reduction. At baseline, there were no significant differences in pain severity between the groups (mean PEG, 7.08 vs. 6.73 vs. 7.07 for past year involuntary opioid reduction, past year voluntary opioid reduction, and no past year opioid reduction, respectively; P = 0.32). For the primary outcome of change in pain severity from baseline to 18 months, there were no significant differences between groups (mean PEG change, - 0.05 vs. - 0.44 vs. - 0.23 for past year involuntary opioid reduction, past year voluntary opioid reduction, and no past year opioid reduction, respectively; P = 0.28). CONCLUSIONS:Self-reported past year involuntary opioid reduction was common among a national sample of veterans treated with long-term opioid therapy. Opioid dose reduction, whether involuntary or voluntary, was not associated with change in pain severity. Future studies should examine involuntary opioid reduction in different populations and trends over time and explore further patient- and provider-level factors that may impact patient experience and outcomes during opioid reduction.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Frank JW,Carey E,Nolan C,Hale A,Nugent S,Krebs EE

doi

10.1007/s11606-020-06294-z

subject

Has Abstract

pub_date

2020-12-01 00:00:00

pages

910-917

issue

Suppl 3

eissn

0884-8734

issn

1525-1497

pii

10.1007/s11606-020-06294-z

journal_volume

pub_type

杂志文章

在线工具

Association Between Opioid Dose Reduction Against Patients' Wishes and Change in Pain Severity.