Opioid therapy for chronic noncancer back pain - A randomized prospective study

被引:223
作者
Jamison, RN [1 ]
Raymond, SA [1 ]
Slawsby, EA [1 ]
Nedeljkovic, SS [1 ]
Katz, NP [1 ]
机构
[1] Harvard Univ, Sch Med, Brigham & Womens Hosp, Dept Anesthesia,Pain Management Ctr, Boston, MA 02115 USA
关键词
adverse effects; chronic back pain; compliance; helpfulness ratings; opioid therapy; outcome; pain report;
D O I
10.1097/00007632-199812010-00014
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. A randomized, open, long-term, repeated-dose comparison of an anti-inflammatory drug and two opioid regimens in 36 patients with back pain. Objectives. To examine the long-term safety and efficacy of chronic opioid therapy in a randomized trial of patients with back pain. Methods. All participants underwent a 4-week washout period of no opioid medication before being randomly assigned to one of three treatment regimens for 16 weeks: 1) naproxen only, 2) set-dose oxycodone, or 3) titrated-dose oxycodone and sustained-release morphine sulfate. All patients then were assigned to a titrated dose of opioids for 16 weeks and then gradually tapered off their medication for 12 weeks. Finally, all participants were monitored for a 1-month posttreatment washout period. Each patient was called once a week for a report on pain, activity, mood, medication, hours awake, and adverse effects and as monitored carefully for signs of abuse and noncompliance. Results. Weekly reports during the experimental phase showed the titrated-dose group to have less pain (P < 0.001) and less emotional distress (P < 0.001) than the other two groups. Both opioid groups were significantly different from the naproxen-only group. During the titration phase, patients also reported significantly less pain and improved mood. Few differences were found in activity or hours asleep, or between average pretreatment and post-treatment phone-interview and questionnaire variables. No adverse events occurred, and only one participant showed signs of abuse behavior. Conclusions. The results suggest that opioid therapy has a positive effect on pain and mood but little effect on activity and sleep. Opioid therapy for chronic back pain was used without significant risk of abuse. However, tapered-off opioid treatment is palliative and without long-term benefit.
引用
收藏
页码:2591 / 2600
页数:10
相关论文
共 41 条
  • [1] [Anonymous], 1996, MASTERING CHRONIC PA
  • [2] [Anonymous], NARCOTIC ANALGESICS
  • [3] [Anonymous], 1996, LEARNING MASTER YOUR
  • [4] BRENA SF, 1991, APS B, V1, P7
  • [5] BUCKLEY FP, 1986, PAIN, V5, P223
  • [6] SCREENING FOR ALCOHOL-ABUSE USING THE CAGE QUESTIONNAIRE
    BUSH, B
    SHAW, S
    CLEARY, P
    DELBANCO, TL
    ARONSON, MD
    [J]. AMERICAN JOURNAL OF MEDICINE, 1987, 82 (02) : 231 - 235
  • [7] OUTPATIENT TREATMENT OF PATIENTS WITH CHRONIC PAIN - AN ANALYSIS OF COST SAVINGS
    CICALA, RS
    WRIGHT, H
    [J]. CLINICAL JOURNAL OF PAIN, 1989, 5 (03) : 223 - 226
  • [8] Cohen J., 1988, STAT POWER ANAL BEHA, DOI 10.1016/C2013-0-10517-X
  • [9] Derogatis L. R., 1977, SCL 90 ADM SCORING P
  • [10] DEROGATIS LR, 1983, SCL 90 R MAN, V2