共享决策和停止治疗阿片类药物治疗慢性疼痛
John C Licciardone1, Michaela Digilio2, Subhash Aryal2
1From the University of North Texas Health Science Center, Forth Worth, TX (JCL, MD); Johns Hopkins University, Baltimore, MD (SA). john.licciardone@unthsc.edu.
Journal of the American Board of Family Medicine : JABFM
|June 27, 2025
概括
共享决策 (SDM) 并没有减少长期处方阿片类药物治疗慢性疼痛. 虽然SDM至关重要,但它本身不足以改善患者的阿片类药物处方结果.
科学领域:
- 疼痛管理 疼痛管理
- 医疗保健服务研究 医疗服务研究
- 临床决策 - 临床决策
背景情况:
- 对慢性疼痛而言,阿片类药物治疗是常见的,因此需要研究有效的共享决策 (SDM) 策略.
- SDM对阿片类药物治疗中止和处方模式的影响需要进一步调查.
研究的目的:
- 评估共享决策 (SDM) 对慢性疼痛患者停用阿片类药物治疗和处方频率的影响.
- 评估SDM与患者结局之间的关联,包括疼痛,功能和生活质量.
主要方法:
- 使用国家疼痛登记册 (2016年9月 - 2024年1月) 进行目标试验模拟.
- 分析了328名因慢性腰痛而接受阿片类药物治疗的患者,比较了SDM较大和较小的组.
- 测量结果包括12个月的阿片类药物停用,处方频率,疼痛,功能和生活质量.
主要成果:
- 较大的SDM与较少的短期停用阿片类药物 (基线后3个月) 有关.
- 增加的SDM与更频繁的长期阿片类药物处方 (基线后3-12个月) 有关.
- 随着SDM的增加,没有观察到疼痛,功能或生活质量的临床显著改善.
结论:
- 共享决策 (SDM) 与短期停用阿片类药物减少,但长期处方增加有关.
- SDM是改善慢性疼痛管理中阿片类药物处方实践的必要但不足的组成部分.
- 目前的SDM方法似乎没有与阿片类药物治疗结合来改善患者的治疗结果.
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