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IF 2.6 3区医学 Q2 ANESTHESIOLOGY

Clinical Journal of Pain Pub Date : 2025-02-01 DOI:10.1097/AJP.0000000000001266

Casey León, Minhee L Sung, Joel I Reisman, Weisong Liu, Robert D Kerns, Kirsha S Gordon, Avijit Mitra, Sunjae Kwon, Hong Yu, William C Becker, Wenjun Li

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引用次数: 0

摘要

目的：神经认知症状（NCS）可能是阿片类药物相关伤害的早期指标。我们旨在通过使用自然语言处理（NLP）从退伍军人健康管理局（Veterans Health Administration）的电子健康记录（EHR）中提取数据，评估长期阿片类药物治疗（LTOT）患者中阿片类药物相关神经认知症状的发生率和潜在归因：我们对2018年开具LTOT处方的患者进行了一项回顾性队列研究。从临床记录中确定了三个时期的非症状：LTOT 开始前 6 个月、LTOT 期间和 LTOT 停止后一年。阿片类药物相关非症状包括认知障碍、镇静、头晕、精神状态改变和中毒。我们计算了发病率、发病率比 (IRR) 和危险比 (HR)，以评估这些时期内非典型肺炎的发生率和可能的阿片类药物归因：在 55,652 名患者中，3.1% 的患者经历了与阿片类药物相关的 NCS，其中在长期服药期间的发生率最高。在以下年龄段的患者中，NCS发生率更高：55-64岁（3.6%）或65-74岁（3.2%）、亚裔（4.8%，P=0.02）、接受过药物使用障碍治疗（7.1%，P=0.01）。在调整后的比例危险模型中，确定了亚洲人种（HR 2.20，95% CI [1.09-4.44]，P=0.03）、并发症痴呆症（1.50 [1.12-2.00]，0.01）、抑郁症（1.31 [1.14-1.49]，0.01）、创伤后应激障碍（1.18 [1.02-1.37]，0.02）、药物使用障碍（1.62 [1.36-1.92]，0.01）、心血管疾病（1.18 [1.01-1.37]，0.04）、慢性阻塞性肺部疾病（1.16 [1.01-1.33]，0.03）、肝硬化（1.73 [1.34-2.24]，0.01）、慢性肾脏疾病（1.41 [1.19，1.66]；0.01）和创伤性脑损伤（1.42 [1.06-1.91]，0.02）与发生非典型肺炎的可能性增加有关。NCS的可能性随LTOT剂量的增加而增加，随LTOT持续时间的延长而减少：本研究表明，与阿片类药物相关的 NCS 最有可能发生在 LTOT 期间，这表明与阿片类药物的使用存在潜在的时间关联。这些研究结果突出表明，作为减轻阿片类药物相关危害的更广泛策略的一部分，监测接受低剂量治疗的患者的非昏迷状态非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Occurrence of Opioid-Related Neurocognitive Symptoms Associated With Long-term Opioid Therapy.

Objective: Neurocognitive symptoms (NCSs) may be early indicators of opioid-related harm. We aimed to evaluate the incidence and potential attribution of opioid-related NCS among patients on long-term opioid therapy (LOT) by using natural language processing to extract data from the electronic health records within the Veterans Health Administration.

Methods: We conducted a retrospective cohort study of patients prescribed LOT in 2018. NCS were identified from clinical notes across 3 periods: 6 months before LOT initiation, during LOT, and 1-year post-LOT discontinuation. Opioid-related NCS included cognitive impairment, sedation, light-headedness, altered mental status, and intoxication. We calculated incidence rates, incidence rate ratios, and hazard ratios to evaluate the occurrence and potential opioid attribution of NCS across these periods.

Results: Among 55,652 patients, 3.1% experienced opioid-related NCS, with the highest incidence observed during LOT. Prevalence of NCS was greater in patients who were: between 55 and 64 (3.6%) or 65 and 74 years old (3.2%), Asian (4.8%, P = 0.02), and had received treatment for substance use disorders (7.1%, P = 0.01). In adjusted proportional hazards models, identified Asian race (hazard ratio: 2.20 [95% CI: 1.09-4.44], P = 0.03), and cooccurring conditions dementia (1.50 [1.12-2.00], 0.01), depression (1.31 [1.14-1.49], <0.01), posttraumatic stress disorder (1.18 [1.02-1.37], 0.02), substance use disorder (1.62 [1.36-1.92], 0.01), cardiovascular disease (1.18 [1.01-1.37], 0.04), chronic obstructive pulmonary disease (1.16 [1.01-1.33], 0.03), cirrhosis (1.73 [1.34-2.24], 0.01), chronic kidney disease (1.41 [1.19, 1.66]; 0.01) and traumatic brain injury (1.42 [1.06-1.91], 0.02) were associated with increased likelihood of NCS. Likelihood of NCS increased with LOT dose and decreased with LOT duration.

Conclusion: This study suggests that opioid-related NCS are most likely to occur during LOT, indicating a potential temporal association with opioid use. These findings highlight the importance of monitoring NCS in patients on LOT as part of a broader strategy to mitigate opioid-related harms.

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来源期刊

Clinical Journal of Pain 医学-临床神经学

CiteScore

5.40

自引率

3.40%

发文量

118

审稿时长

4-8 weeks

期刊介绍： The Clinical Journal of Pain explores all aspects of pain and its effective treatment, bringing readers the insights of leading anesthesiologists, surgeons, internists, neurologists, orthopedists, psychiatrists and psychologists, clinical pharmacologists, and rehabilitation medicine specialists. This peer-reviewed journal presents timely and thought-provoking articles on clinical dilemmas in pain management; valuable diagnostic procedures; promising new pharmacological, surgical, and other therapeutic modalities; psychosocial dimensions of pain; and ethical issues of concern to all medical professionals. The journal also publishes Special Topic issues on subjects of particular relevance to the practice of pain medicine.