Real-world patterns of analgesic combination therapy and their associations with pain intensity and treatment modification in patients with chronic non-cancer pain : A retrospective observational study.

چکیده اصلی

BACKGROUND: Chronic non-cancer pain (CNCP) is highly prevalent and often requires analgesic combination therapy due to its complex mechanisms. However, real-world evidence on how different combination regimens correlate with pain relief and treatment modification remains limited, which hampers optimal multimodal analgesia selection. OBJECTIVES: To explore real‑world analgesic combination patterns in CNCP, analyze their associations with pain intensity changes and regimen adjustments and provide evidence for individualized multimodal analgesia. METHODS: This retrospective study included 120 CNCP patients (Jan 2022 to Jan 2024) categorized into three regimens: Dual (NSAIDs + acetaminophen, n=42), Opioid (weak opioid + adjuvant, n=38) and Triple (NSAIDs + opioid + adjuvant, n=40). Numerical Rating Scale (NRS) scores, therapy duration, regimen adjustments and adverse reactions were extracted. Multiple linear regression and binary logistic regression were used to identify factors associated with pain relief and treatment modification. RESULTS: The Triple group achieved the highest pain-relief rate (77.5%) compared with the Opioid (63.2%) and Dual (50.0%) groups (P<0.05). The treatment modification rate was highest in the Dual group (45.2%, mainly escalation; P<0.05). Adverse reactions were more frequent in the Triple group than in the Dual group (P<0.05), but no serious events occurred. Regression analyses identified Triple therapy (B=0.455, 95% CI: 0.260-0.649, P<0.001) and baseline NRS (B=0.607, 95% CI: 0.491-0.723, P<0.001) as independent factors for greater pain relief. Triple therapy (OR=0.256, 95% CI: 0.090-0.729, P=0.011) and longer baseline pain duration (OR=0.917, 95% CI: 0.860-0.978, P=0.009) were independent protective factors against treatment modification. CONCLUSION: CNCP patients exhibit distinct patterns of analgesic combination. Triple therapy was associated with better pain relief persistence and fewer adjustments but higher adverse reaction risks. Therapy selection should be stratified by pain phenotype and patients with moderate‑to‑severe pain may benefit from early standardized combination therapy, which was linked to fewer subsequent regimen adjustments.

ترجمه فارسی چکیده

در این مطالعه بازگشت‌پذیر، الگوهای درمان ترکیبی ضد درد در ۱۲۰ بیمار با درد مزمن غیرسرطانی (ژانویه ۲۰۲۲ تا ژانویه ۲۰۲۴) بررسی شد. بیماران به سه رژیم تقسیم شدند: دوگانه (دوپاداروی ضدالتهابی غیراستروئیدی + استامینوفن)، مخدر (مخدر ضعیف + کمکی) و سه‌گانه (دوپاداروی ضدالتهابی غیراستروئیدی + مخدر + کمکی). نمره مقیاس عددی درد (NRS)، مدت درمان، تغییرات رژیم و واکنش‌های نامطلوب استخراج شدند. تحلیل‌های رگرسیونی نشان دادند که درمان سه‌گانه و نمره پایه NRS عوامل مستقل برای کاهش درد بهتر هستند. درمان سه‌گانه و مدت طولانی‌تر درد پایه عوامل محافظتی علیه تغییر درمان هستند. درمان سه‌گانه بیشترین نرخ بهبود درد (۷۷.۵٪) را داشت، اما نرخ تغییر درمان در گروه دوگانه (۴۵.۲٪) بالاتر بود.

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