吸烟状态对于慢性疼痛患者戒除阿片类药物的影响  

作　　者：W. Michael Hooten, MD Cynthia O. Townsend, PhD Barbara K. Bruce, PhD David O. Warner, MD 厉彩霞(译) 方向明(校) 

机构地区：[1]Departments of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota [2]Departments of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota [3]不详

出　　处：《麻醉与镇痛》2011年第2期78-85,共8页Anesthesia & Analgesia

摘　　要：目的本研究主要探讨吸烟是否将影响慢性疼痛患者在为期3周的疼痛康复项目中阿片类药物的减量，同时，探讨吸烟状态、住院期间阿片类药物的使用及疼痛的严重程度之间的关系。方法作者使用了回顾性、重复测试的试验设计以评估患者在治疗前后的一些指标。评估的对象是在2003年9月至2007年2月之间接受一项为期3周的门诊疼痛治疗项目的全部患者。评估指标包括阿片类药物的成功戒除率、多学科疼痛调查的疼痛程度量表和治疗项目完成情况。结果共有1241例患者纳入本研究（女性928例）；其中，313例（25％）是吸烟者，294例（24％）是前烟民，其余634例（51％）未曾吸烟。入组时，相较于前烟民及不吸烟者，有更多的吸烟者住院期间使用阿片类药物（P〈0．001）。吸烟者使用的平均等效吗啡剂量（P=0．013）和疼痛评分（P〈0．001）明显高于前烟民和不吸烟者。阿片类药物的成功戒除率与患者是否吸烟无关，治疗项目结束时，各组患者的疼痛均有明显缓解（P〈0．001）。但是，有较大比例的吸烟者未能完成3周的治疗疗程（P〈0．001）。结论大部分完成全部疼痛康复计划的患者能够成功戒除阿片类药物，这与患者是否吸烟无关。但值得注意的是，有更多的吸烟者未能完成该治疗项目，其中最常见的原因包括对治疗的期望值存在差异，突发急性疾病，以及心理社会的应激。OBJECTIVE： The primary aim of this study was to determine if smoking status affected the ability of patients with chronic pain to reduce opioid consumption during a 3-wk pain rehabilitation program. Secondary aims induded determining the associations between smoking status, admission opioid use, and pain severity. METHODS： We used a retrospective, repeated measures design to assess pre- and post-treatment outcomes in a consecutive series of patients admitted to a 3-wk, outpatient pain treatment program from September 2003 through February 2007. Outcome measures included the frequency of successful opioid tapering, pain severity subscale of the Multidisciplinary Pain Inventory, and program completion status. RESULTS： The study cohort included 1241 patients （women 928）; 313 （25%） smokers, 294 （24%） former smokers, and 634 （51%） never smokers. There were more smokers using opioids at admission （P 〈 0. 001） compared to former and never smokers. Likewise, the mean morphine equivalent dose （P = 0.013） and pain severity scores （P 〈 0. 001） of smokers were higher compared to former and never smokers. The success of opioid tapering did not depend on smoking status, and all groups experienced significant reductions in pain severity at program completion （P 〈 0.001）. However, a higher proportion of smokers did not complete treatment （P 〈 0. 001 ）. CONCLUSIONS： For patients completing a pain rehabilitation program, most were able to eliminate opioid use, regardless of smoking status. However, significantly more smokers did not complete treatment. The most frequent reasons for program noncompletion included discrepant expectations of treatment, acute illness, and psychosodal stressors.

关 键 词：阿片类药物 疼痛患者 不吸烟者 慢性 状态 治疗前后 评估指标 疼痛康复 

分 类 号：R971.1[医药卫生—药品]