PDF(Pubmed)
Abstract：
OBJECTIVE: To identify common opioid tapering trajectories among patients commencing opioid taper from long-term opioid therapy for chronic non-cancer pain and to examine patient-level characteristics associated with these different trajectories.
METHODS: A retrospective cohort study.
METHODS: Australian primary care.
METHODS: Patients prescribed opioid analgesics between 2015 and 2020.
METHODS: Group-based trajectory modeling and multinomial logistic regression analysis were conducted to determine tapering trajectories and to examine demographic and clinical factors associated with the different trajectories.
RESULTS: A total of 3369 patients commenced a taper from long-term opioid therapy. Six distinct opioid tapering trajectories were identified: low dose / completed taper (12.9%), medium dose / faster taper (12.2%), medium dose / gradual taper (6.5%), low dose / noncompleted taper (21.3%), medium dose / noncompleted taper (30.4%), and high dose / noncompleted taper (16.7%). A completed tapering trajectory from a high opioid dose was not identified. Among patients prescribed medium opioid doses, those who completed their taper were more likely to have higher geographically derived socioeconomic status (relative risk ratio [RRR], 1.067; 95% confidence interval [CI], 1.001-1.137) and less likely to have sleep disorders (RRR, 0.661; 95% CI, 0.463-0.945) than were those who didn\'t complete their taper. Patients who didn\'t complete their taper were more likely to be prescribed strong opioids (eg, morphine, oxycodone), regardless of whether they were tapered from low (RRR, 1.444; 95% CI, 1.138-1.831) or high (RRR, 1.344; 95% CI, 1.027-1.760) doses.
CONCLUSIONS: Those prescribed strong opioids and high doses appear to be less likely to complete tapering. Further studies are needed to evaluate the clinical outcomes associated with the identified trajectories.
METHODS: A retrospective cohort study.
METHODS: Australian primary care.
METHODS: Patients prescribed opioid analgesics between 2015 and 2020.
METHODS: Group-based trajectory modeling and multinomial logistic regression analysis were conducted to determine tapering trajectories and to examine demographic and clinical factors associated with the different trajectories.
RESULTS: A total of 3369 patients commenced a taper from long-term opioid therapy. Six distinct opioid tapering trajectories were identified: low dose / completed taper (12.9%), medium dose / faster taper (12.2%), medium dose / gradual taper (6.5%), low dose / noncompleted taper (21.3%), medium dose / noncompleted taper (30.4%), and high dose / noncompleted taper (16.7%). A completed tapering trajectory from a high opioid dose was not identified. Among patients prescribed medium opioid doses, those who completed their taper were more likely to have higher geographically derived socioeconomic status (relative risk ratio [RRR], 1.067; 95% confidence interval [CI], 1.001-1.137) and less likely to have sleep disorders (RRR, 0.661; 95% CI, 0.463-0.945) than were those who didn\'t complete their taper. Patients who didn\'t complete their taper were more likely to be prescribed strong opioids (eg, morphine, oxycodone), regardless of whether they were tapered from low (RRR, 1.444; 95% CI, 1.138-1.831) or high (RRR, 1.344; 95% CI, 1.027-1.760) doses.
CONCLUSIONS: Those prescribed strong opioids and high doses appear to be less likely to complete tapering. Further studies are needed to evaluate the clinical outcomes associated with the identified trajectories.
摘要：
目的：确定长期阿片类药物治疗慢性非癌性疼痛开始逐渐变细的患者中常见的阿片类药物逐渐变细轨迹，并检查与这些不同轨迹相关的患者水平特征。
方法：回顾性队列研究。设置。澳大利亚初级保健。
方法：患者在2015年至2020年之间开了阿片类镇痛药。
方法：进行了基于组的轨迹建模和多项逻辑回归分析，以确定锥度轨迹，并检查与不同轨迹相关的人口统计学和临床因素。
结果：共有3,369名患者从长期阿片类药物治疗开始逐渐减少。确定了六个不同的阿片类药物锥度轨迹：低剂量，完成锥度(12.9%)；中等剂量，更快的锥度（12.2%）；中等剂量，逐渐锥度（6.5%）；低剂量，未完成锥度(21.3%)；中等剂量，未完成锥度(30.4%)；高剂量，未完成锥度（16.7%）。未确定高阿片类剂量的完整锥度轨迹。对于规定中等剂量阿片类药物的患者，那些完成缩减的人更有可能具有更高的地理来源的社会经济地位(相对风险比[RRR]，1.067；95%置信区间[CI]，1.001-1.137)和不太可能有睡眠障碍(RRR，0.661；95%CI，0.463-0.945），与那些没有完全锥度的人相比。没有完全锥度的患者更有可能服用强阿片类药物(例如吗啡，羟考酮)，无论它们是否从低逐渐变细(RRR，1.444；95%CI，1.138-1.831）或高（RRR，1.344；95%CI，1.027-1.760）剂量。
结论：那些规定的强阿片类药物和高剂量似乎不太可能完成锥度。需要进一步的研究来评估与确定的轨迹相关的临床结果。
方法：回顾性队列研究。设置。澳大利亚初级保健。
方法：患者在2015年至2020年之间开了阿片类镇痛药。
方法：进行了基于组的轨迹建模和多项逻辑回归分析，以确定锥度轨迹，并检查与不同轨迹相关的人口统计学和临床因素。
结果：共有3,369名患者从长期阿片类药物治疗开始逐渐减少。确定了六个不同的阿片类药物锥度轨迹：低剂量，完成锥度(12.9%)；中等剂量，更快的锥度（12.2%）；中等剂量，逐渐锥度（6.5%）；低剂量，未完成锥度(21.3%)；中等剂量，未完成锥度(30.4%)；高剂量，未完成锥度（16.7%）。未确定高阿片类剂量的完整锥度轨迹。对于规定中等剂量阿片类药物的患者，那些完成缩减的人更有可能具有更高的地理来源的社会经济地位(相对风险比[RRR]，1.067；95%置信区间[CI]，1.001-1.137)和不太可能有睡眠障碍(RRR，0.661；95%CI，0.463-0.945），与那些没有完全锥度的人相比。没有完全锥度的患者更有可能服用强阿片类药物(例如吗啡，羟考酮)，无论它们是否从低逐渐变细(RRR，1.444；95%CI，1.138-1.831）或高（RRR，1.344；95%CI，1.027-1.760）剂量。
结论：那些规定的强阿片类药物和高剂量似乎不太可能完成锥度。需要进一步的研究来评估与确定的轨迹相关的临床结果。
