No comparative effectiveness data exist on nonopioid analgesics and nonbenzodiazepine anxiolytics to treat pain with anxiety. We examined the relationship between drug class and central nervous system (CNS) active drug polypharmacy on pain and anxiety levels in Medicare enrollees receiving home health (HH) care. This retrospective cohort study included enrollees with diagnoses and 2+ assessments of pain and anxiety between HH admission and discharge. Three sets of linear regression difference-in-reduction analyses assessed the association of pain or anxiety reduction with number of drugs; drug type; and drug combinations in those with daily pain and daily anxiety. Logistic regression analysis assessed the effect of medication number and class on less-than-daily pain or anxiety at HH discharge. A sensitivity analysis using multinomial regression was conducted with a three-level improvement to further determine clinical significance. Of 85,403 HH patients, 43% received opioids, 27% benzodiazepines, 26% gabapentinoids, 32% selective serotonin reuptake inhibitors, and 8% serotonin and norepinephrine reuptake inhibitors (SNRI). Furthermore, 75% had depression, 40% had substance use disorder diagnoses, and 6.9% had PTSD diagnoses. At HH admission, 83%, 35%, and 30% of patients reported daily pain, daily anxiety, and both, respectively. Central nervous system polypharmacy was associated with worse pain control and had no significant effect on anxiety. For patients with daily pain plus anxiety, pain was best reduced with one medication or any drug combination without opioid/benzodiazepine; anxiety was best reduced with combinations other than opiate/benzodiazepine. Gabapentinoids or SNRI achieved clinically meaningful pain control. Selective serotonin reuptake inhibitors provided clinically meaningful anxiety relief.

中文翻译：

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接受家庭医疗保健的 Medicare 参保者的中枢神经系统积极药物使用：与慢性疼痛和焦虑水平的关联。


没有关于非阿片类镇痛药和非苯二氮卓类抗焦虑药治疗疼痛和焦虑的比较有效性数据。我们检查了药物类别与中枢神经系统 （CNS） 活性药物多药治疗对接受家庭健康 （HH） 护理的 Medicare 参保者疼痛和焦虑水平之间的关系。这项回顾性队列研究包括对 HH 入院和出院之间的疼痛和焦虑进行诊断和 2+ 评估的登记者。三组线性回归减少差异分析评估了疼痛或焦虑减轻与药物数量的关联;药物类型;以及每天疼痛和每天焦虑的人的药物组合。Logistic 回归分析评估了药物数量和类别对 HH 出院时少于每日疼痛或焦虑的影响。使用多项式回归进行敏感性分析，改善三级，以进一步确定临床意义。在 85,403 名 HH 患者中，43% 接受了阿片类药物，27% 接受了苯二氮卓类药物，26% 接受了加巴喷丁类药物，32% 接受了选择性血清素再摄取抑制剂，以及 8% 接受了血清素和去甲肾上腺素再摄取抑制剂 （SNRI）。此外，75% 的人患有抑郁症，40% 的人被诊断为物质使用障碍，6.9% 的人被诊断为 PTSD。在 HH 入院时，83% 、 35% 和 30% 的患者分别报告了每日疼痛、每日焦虑和两者兼而有之。中枢神经系统多药治疗与较差的疼痛控制相关，对焦虑无显著影响。对于每天疼痛加焦虑的患者，使用一种药物或任何不含阿片类药物/苯二氮卓类药物的药物组合可以最好地减轻疼痛;阿片类药物/苯二氮卓类药物以外的联合治疗最能减轻焦虑。加巴喷丁类药物或 SNRI 实现了具有临床意义的疼痛控制。 选择性 5-羟色胺再摄取抑制剂提供了具有临床意义的焦虑缓解。