早期疼痛控制有助於失眠的治療

Early Treatment of Pain Benefits Insomnia Treatment

背景及目的：如大家所熟知，疼痛和睡眠障礙間，存在著相互影響的關係。從已知證據中顯示，受睡眠障礙所苦的病人，對於疼痛的刺激會較為敏感。到目前為止，早期疼痛治療對於睡眠障礙影響的研究，尤其是針對亞洲患者，很少著墨。因此，我們試圖藉由台灣超過兩千三百萬位民眾納保的全民健保資料庫，來研究是否能藉由早期處理失眠病人可能伴隨的疼痛症狀，而有助於其失眠障礙的治療。研究設計：本研究採用全民健保資料庫2000年承保抽樣歸人檔（LHID2000），以ICD-9-CM診斷碼篩選出於西元2000年到2005年，因失眠就醫並且服用助眠藥物的病人，追蹤其失眠後一年間失眠用藥的使用情形。比較早期（失眠診斷後第一季內）開始接受非類固醇消炎劑治療的病人，追蹤失眠後每一季度的失眠用藥使用量是否有明顯下降。實驗結果：共有1，287位失眠病人從2000年承保抽樣歸人檔中篩選出來，其中426位病人被選定為對照組（追蹤期間皆未服用NSAIDs），篩選出的實驗組患者為10位。結果兩組病人助眠藥物使用量皆隨著追蹤季度而下降，早期接受非類固醇消炎劑治療的失眠病人（實驗組）仍需使用助眠藥物的比例在第三季度後明顯降低。就藥物處方劑量來看，實驗組的平均每季使用劑量皆較對照組低，且兩組的處方劑量皆隨追蹤季度下降。研究結論：本研究依據健保資料庫的數據分析，應可為醫療決策時提供有效的證據。根據本研究分析結果，我們建議在面對失眠病人時，應先診斷是否同時有疼痛的病灶，並給予適當的治療，可以幫助失眠治療的成效。

Background & Aims : Pain is known to be interrelated to sleep disturbance. Insomnia is prevalent among patients with chronic pain. Patients suffer from sleeping disorders are proved to be more sensitive to painful stimulation. Yet, the impact of pain management on insomnia, especially in Asia population, is seldom investigated. Therefore, we use a nationwide health insurance database in Taiwan with a population over 23 million to explore whether the early use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain management may help patients with insomnia. Methods: We analyzed the data sourced from the Longitudinal Health Insurance Database 2000 (LHID 2000) of Taiwan National Health Insurance Research Database (NHIRD), and selected subjects who were newly diagnosed as insomnia by ICD-9-CM Codes and their treatment period longer than one month during 2000 to 2005, and study group were patients who were also early (within first quarter) use of NSAIDs after insomnia diagnosed. Wilcoxon rank sum test was used to exam the utility of hypnotics between groups in the subsequent four quarters. Results: 1,287 patients were sampled as insomnia from LHID 2000. 426 patients were selected as control group (insomniacs without use of NSAIDs) and 10 patients were identified as the study group (insomniacs with NSAIDs use). The average usage of hypnotics and sedatives of both groups decreased over time, and this is lower in the study group than in the control group. The proportion of patients stayed on either hypnotics or sedatives prescriptions in both groups were decreased in the follow-up quarters, and this is significantly lower in study group after the third quarter. Conclusion: The results of such a large population-based health insurance database may provide useful evidence for medical decision. Based on current data, we suggest that proper identification and management of underlying or co-existing painful disorders might be beneficial for patients suffering from sleep disturbance.