患有酒精使用障碍的患者会增加疼痛和镇痛药的使用：一项基于全国人口的队列研究。

Patients with alcohol use disorder increase pain and analgesics use: A nationwide population-based cohort study.

机构信息

Department of Pharmacology, National Defense Medical Center, Taipei 11490, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan; Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.

Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan; School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan; Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.

出版信息

Drug Alcohol Depend. 2021 Dec 1;229(Pt A):109102. doi: 10.1016/j.drugalcdep.2021.109102. Epub 2021 Sep 24.

DOI:10.1016/j.drugalcdep.2021.109102

PMID:34634646

Abstract

BACKGROUND

Alcohol has dual effects on many systems, including the pain system. We will test whether and how chronic alcohol consumption enhances pain sensation to develop pain disorder.

METHODS

We conducted a retrospective matched cohort study using data from the National Health Insurance Research Database (NHIRD) in Taiwan, in patients with and without alcohol use disorder (AUD). This study enrolled 19,174 individuals with AUD as study cohort and 19,174 propensity score-matched individuals without AUD as comparison cohort. The outcome was the incidence of pain disorders and the need for analgesics. The hazard ratios of pain disorders and the need for analgesics were evaluated using Cox proportional hazard regression analysis after adjusting for age, sex, index year, comorbidities, urbanization, areas of residence, and insurance premium.

RESULTS

The 14 years of follow-up showed that AUD patients had a higher adjusted hazard ratio (aHR) for developing pain disorders than in non-AUD controls [aHR= 1.290, 95% confidence interval (CI): 1.045-1.591]. Besides, AUD patients had a higher risk of analgesic use (aHR = 1.081, 95% CI: 1.064-1.312), including opioids and non-opioid analgesics. Most importantly, AUD patients required more days of analgesic use, increased dose of analgesics, and higher costs of analgesics. Moreover, AUD patients had more anemia (aHR=2.772, 95% CI: 2.581-2.872), which could be a mediating factor.

CONCLUSIONS

AUD patients had higher risks of developing pain disorders and subsequently increased analgesic demand. These results suggest that AUD worsened pain, and pain syndrome is correlated with the duration of chronic alcohol exposure.

摘要

背景

酒精对包括疼痛系统在内的许多系统具有双重影响。我们将检验慢性酒精摄入是否以及如何增强疼痛感觉以发展为疼痛障碍。

方法

我们使用来自台湾全民健康保险研究数据库（NHIRD）的数据进行了一项回顾性匹配队列研究，其中包括有和没有酒精使用障碍（AUD）的患者。这项研究纳入了 19174 名 AUD 患者作为研究队列，以及 19174 名按倾向得分匹配的无 AUD 患者作为对照队列。结局是疼痛障碍的发生率和对镇痛药的需求。使用 Cox 比例风险回归分析调整年龄、性别、指数年、合并症、城市化程度、居住地区和保险费后，评估疼痛障碍和镇痛药需求的风险比。

结果

14 年的随访显示，AUD 患者发生疼痛障碍的调整后风险比（aHR）高于非 AUD 对照组 [aHR=1.290，95%置信区间（CI）：1.045-1.591]。此外，AUD 患者使用镇痛药（aHR=1.081，95%CI：1.064-1.312）的风险更高，包括阿片类药物和非阿片类镇痛药。最重要的是，AUD 患者需要更多天的镇痛药使用、增加镇痛药剂量和更高的镇痛药费用。此外，AUD 患者更易发生贫血（aHR=2.772，95%CI：2.581-2.872），这可能是一个中介因素。