Impact of reported NSAID “allergies” on opioid use disorder in back pain,Journal of Allergy and Clinical Immunology

当前位置： X-MOL 学术 › J. Allergy Clin. Immunol. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Impact of reported NSAID “allergies” on opioid use disorder in back pain
Journal of Allergy and Clinical Immunology ( IF 11.4 ) Pub Date : 2020-09-09 , DOI: 10.1016/j.jaci.2020.08.025
Lily Li ₁ , Yuchiao Chang ₂ , Shuang Song ₃ , Elena Losina ₄ , Karen H Costenbader ₅ , Tanya M Laidlaw ₆

Affiliation

Background

It is crucial to identify patients at highest risk for opioid use disorder (OUD) and to address challenges in reducing opioid use. Reported nonsteroidal anti-inflammatory drug (NSAID) allergies may predispose to use of stronger pain medications and potentially to OUD.

Objective

We sought to investigate the clinical impact of reported NSAID allergy on OUD in patients with chronic back pain.

Methods

We conducted a retrospective study of adults receiving care at a tertiary health care system from January 1, 2013, to December 31, 2018. Back pain and OUD were identified using administrative data algorithms. We used propensity score matching and logistic regression to estimate the impact of self-reported NSAID adverse drug reactions (ADRs) on risk of OUD, adjusting for other relevant clinical information.

Results

Of 47,114 patients with chronic back pain, 3,620 (7.7%) had a reported NSAID ADR. In an adjusted propensity score–matched analysis, patients with NSAID ADRs had higher odds (odds ratio, 1.34; 95% CI, 1.07-1.67) of developing OUD as compared with those without NSAID ADRs. Additional risk factors for OUD included younger age, male sex, Medicaid insurance, Medicare insurance, higher number of inpatient and outpatient visits in the previous year, and comorbid anxiety and depression. Patients with listed NSAID ADRs also had higher odds of a documented opioid prescription during the study period (odds ratio, 1.22; 95% CI, 1.11-1.34).

Conclusions

Adults with chronic back pain and reported NSAID ADRs are at a higher risk of developing OUD and receiving opioid analgesics, even after accounting for comorbidities and health care utilization. Allergy evaluation is critical for potential delabeling of patients with reported NSAID allergies and chronic pain.

中文翻译：

报告的非甾体抗炎药“过敏”对背痛阿片类药物使用障碍的影响

背景

识别阿片类药物使用障碍 (OUD) 风险最高的患者并解决减少阿片类药物使用的挑战至关重要。据报道，非甾体类抗炎药 (NSAID) 过敏可能会导致使用更强效止痛药，并可能导致 OUD 的使用。

客观的

我们试图调查已报告的 NSAID 过敏对慢性背痛患者 OUD 的临床影响。

方法

我们对 2013 年 1 月 1 日至 2018 年 12 月 31 日期间在三级医疗保健系统接受护理的成年人进行了回顾性研究。使用管理数据算法识别背痛和 OUD。我们使用倾向评分匹配和逻辑回归来估计自我报告的 NSAID 药物不良反应 (ADR) 对 OUD 风险的影响，并调整其他相关临床信息。

结果

在 47,114 名慢性背痛患者中，有 3,620 名（7.7%）报告有非甾体抗炎药不良反应。在调整倾向评分匹配分析中，与没有 NSAID ADR 的患者相比，有 NSAID ADR 的患者发生 OUD 的几率更高（比值比，1.34；95% CI，1.07-1.67）。 OUD 的其他危险因素包括年龄较小、男性、医疗补助保险、医疗保险、上一年住院和门诊次数较多以及共病焦虑和抑郁。在研究期间，具有列出的 NSAID ADR 的患者也有较高的记录阿片类药物处方的几率（比值比，1.22；95% CI，1.11-1.34）。