阿片类药物使用障碍的治疗和恢复：疼痛严重程度在中度至重度疼痛个体中的作用

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-09-25 DOI:10.1016/j.drugalcdep.2025.112902

Allison N. Tegge , Marco A.R. Ferreira , Peter M. Garafola , Shuangshuang Xu , Michael Farrell , John Marsden , Ken Lee , Anne Le Moigne , Frank Gray , Warren K. Bickel

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引用次数: 0

摘要

背景：疼痛是阿片类药物使用障碍（OUD）患者常见的合并症，但其对治疗结果的影响尚不清楚。在接受长效丁丙诺啡（BUP-XR）治疗的参与者中，研究了疼痛严重程度与OUD治疗结果之间的关系，包括戒断、渴望、保留和心理功能。该次要数据分析调查了来自BUP-XR 3期项目的参与者：随机临床试验（NCT02357901, N = 192），开放标签研究（NCT02510014, N = 410）；纵向观察随访（NCT03604861; N = 350）。每次治疗时使用简短疼痛量表（BPI）测量疼痛。其他指标包括人口统计、阿片类药物使用、参与者保留、阿片类药物戒断、渴望、抑郁和生活质量。对整个样本和中重度疼痛（BPI≥4）个体亚组进行分析。结果参与者平均年龄40岁，以男性（67%）和白人（66%）为主。开始BUP-XR后疼痛减轻，并且疼痛减轻持续整个治疗过程（p值<；.001）。对于中度至重度疼痛的个体，在两个数据集中，更大的并发疼痛严重程度与更低的戒断率相关（优势比：[0.801,0.852]；p值<； 0.001）。疼痛与参与者记忆保留无关。最后，更严重的疼痛程度与更差的身体生活质量（p-value <.001）和阿片类药物戒断（p-value <.001）、更严重的抑郁（p-value <.001）和阿片类药物渴望（p-value <.001）相关。总的来说，这些发现在三项研究中得到了很好的重复。结论西班牙严重程度是阿片类药物使用和心理社会结局的临床相关预测因素，而不是BUP-XR患者的治疗保留。常规疼痛严重程度监测可以提供对患者轨迹的有价值的见解，并支持更有针对性的OUD治疗方法。

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Treatment and recovery from opioid use disorder: The role of pain severity in individuals with moderate to severe pain

Background

Pain is a frequent comorbidity among individuals with opioid use disorder (OUD), yet its impact on treatment outcomes is unclear. This study examined associations between pain severity and OUD treatment outcomes, including abstinence, craving, retention, and psychological functioning, in participants receiving long-acting buprenorphine (BUP-XR).

Methods

This secondary data analysis investigates participants from a BUP-XR phase 3 program: randomized clinical trial (NCT02357901; N = 192), open-label study (NCT02510014; N = 410); and a longitudinal observational follow-up (NCT03604861; N = 350). Pain was measured using the Brief Pain Inventory (BPI) at each treatment visit. Additional measures included demographics, opioid use, participant retention, opioid withdrawal, craving, depression, and quality of life. Analyses were performed on the full sample and the subgroup of individuals with moderate-to-severe pain (BPI≥4).

Results

Participants averaged 40 years old, predominantly male (67 %) and White (66 %). Pain decreased after starting BUP-XR, and the reduction in pain continued throughout treatment (p-values<.001). For individuals with moderate-to-severe pain, greater concurrent pain severity was associated with lower abstinence rates (odds ratios: [0.801,0.852]; p-values<.001) in two datasets. Pain was not associated with participant retention. Lastly, greater pain severity was associated with worse physical quality of life (p-values<.001) and opioid withdrawal (p-values<.001), and greater depression (p-values<.001) and opioid craving (p-values<.001). Collectively, these findings are well replicated across three studies.

Conclusions

Pain severity is a clinically relevant predictor of opioid use and psychosocial outcomes, but not treatment retention, in patients receiving BUP-XR. Routine pain severity monitoring may provide valuable insight into patient trajectories and support more tailored treatment approaches in OUD.

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.