2013-2022年荷兰初级保健非癌性疼痛患者的患者特征和长期阿片类药物使用的变化：一项基于人群的队列研究

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-06-28 DOI:10.1002/ejp.70061

Loes de Kleijn, Laura Struik, Hanneke J. B. M. Rijkels-Otters, Alessandro Chiarotto, Bart W. Koes, Jacoline J. van den Driest

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引用次数: 0

摘要

背景：基于风险-收益平衡的原因，疼痛指南推荐在非癌症疼痛中取消长期阿片类药物治疗（LTOT）的处方。然而，荷兰初级保健中慢性非癌性疼痛患者LTOT的患病率和随时间的变化尚不清楚。因此，我们检查了患病率和特征，并调查了2013年至2022年间的相关诊断、合并症、联合用药和处方数量的变化。方法：这项基于人群的回顾性队列研究使用Rijnmond初级保健数据库进行，该数据库包括来自鹿特丹大地区至少240名全科医生的50多万例患者记录。纳入2013年至2022年患者年龄为18岁的所有LTOT发作（>； 3个月）。采用描述性统计来描述研究队列的特征。计算2013 - 2022年每100例患者年的LTOT患病率。结果首次使用阿片类药物时，肌肉骨骼疾患是主要的适应症。患者以女性居多（66.9%），平均年龄62.6岁。最常见的合并症包括糖尿病和抑郁症。LTOT的患病率增加了两倍，从2013年的每100例患者年0.54% （95% CI: 0.51-0.58）增加到2022年的1.04% （95% CI: 1.00-1.07）。仅涉及强效阿片类药物的LTOT发作比例在2013年至2022年期间略有增加。该研究表明，从2013年到2022年，荷兰初级保健中慢性非癌性疼痛的lot患病率增加了两倍。肌肉骨骼疼痛是主要的适应症。从2013年到2022年，强效阿片类药物在LTOT中的作用更加突出。2013年至2022年期间，慢性非癌性疼痛的长期阿片类药物治疗增加了约两倍，荷兰初级保健中有效阿片类药物处方的具体增加，突出了对未来研究的迫切需要。这些研究应侧重于制定战略，以加速实施修订后的初级保健疼痛指南，特别是考虑到长期阿片类药物治疗非癌性疼痛的有效性有限，以及由于欧洲人口老龄化，慢性非癌性疼痛的预期上升。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Patient Characteristics and Changes in Long-Term Opioid Use Among Patients With Non-Cancer Pain in Dutch Primary Care 2013–2022: A Population-Based Cohort Study

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Patient Characteristics and Changes in Long-Term Opioid Use Among Patients With Non-Cancer Pain in Dutch Primary Care 2013–2022: A Population-Based Cohort Study

Background

Pain guidelines recommend de-prescribing long-term opioid treatment (LTOT) in non-cancer pain for reasons of risk–benefit balance. However, the prevalence and changes over time with regard to LTOT in patients with chronic non-cancer pain in Dutch primary care are unknown. Hence, we examined the prevalence and characteristics and investigated associated diagnoses, comorbidities, co-medications and changes in prescription numbers between 2013 and 2022.

Methods

This retrospective population-based cohort study was conducted using the Rijnmond Primary Care Database, which includes over 500,000 patient records from at least 240 GPs within the greater region of Rotterdam. All episodes of LTOT (> 3 months) in patients > 18 years from 2013 to 2022 were included. Descriptive statistics were adopted to characterise the study cohort. The prevalence of LTOT from 2013 to 2022 was calculated per 100 patient years.

Results

Musculoskeletal complaints were the main registered indication by the first prescription of opioids. Patients were more frequently female (66.9%), with a mean age of 62.6 years. Most common comorbidities included diabetes mellitus and depressive disorder. The prevalence of LTOT increased twofold from 0.54% (95% CI: 0.51–0.58) per 100 patient years in 2013 to 1.04% (95% CI: 1.00–1.07) in 2022. The proportion of LTOT episodes solely involving potent opioids slightly increased between 2013 and 2022.

Conclusions

This study demonstrated a twofold increase in the prevalence of LTOT for chronic non-cancer pain in Dutch primary care from 2013 to 2022. Musculoskeletal pain complaints were the main indication. From 2013 to 2022 potent opioids assumed a more prominent role in LTOT.

Significance Statement

The about twofold increase in long-term opioid therapy for chronic non-cancer pain between 2013 and 2022, along with the specific rise in potent opioid prescriptions in Dutch primary care, highlights an urgent need for future studies. These studies should focus on developing strategies to accelerate the implementation of revised primary care pain guidelines, especially given the limited effectiveness of long-term opioid treatment in non-cancer pain and the anticipated rise in chronic non-cancer pain due to Europe's ageing population.

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.