Häuser W, Lachiheb H, Grandt D
Medizinische Klinik I, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany.
Z Gastroenterol. 2002 May;40(5):299-303. doi: 10.1055/s-2002-30110.
The occurrence of an opioid addiction within an opioid treatment of pain or diarrhoea in inflammatory bowel disease is rarely reported. We report on a 36-year-old male with a 14 years lasting left sided chronic ulcerative colitis who developed after the initiation of a therapy with tincture of opium because of abdominal pain and diarrhoea an opioid addiction with the consumption of opium and later buprenorphin. Additionally to the diagnostics and therapy of the ulcerative colitis a detoxication was carried out. The diarrhoea slightly increased during the buprenorphin withdrawal. Diarrhoea refractory to other treatment should be treated by loperamid because of its lacking effects on the central nervous system. In chronic abdominal or musculoskeletal pain in inflammatory bowel disease opioids can be used if no surgical or other medical pain relief is possible. A consequent control of the therapeutic and side effects of the opioid therapy is necessary, especially of an abuse of opioid medication. The published case reports of a therapeutic induction of opioid addiction demonstrate that psychiatric comorbidity is an essential or even necessary risk factor. A checklist with seven criteria of opioid addiction during opioid therapy is presented.
在使用阿片类药物治疗疼痛或炎症性肠病腹泻时出现阿片类药物成瘾的情况鲜有报道。我们报告了一名36岁男性，患有长达14年的左侧慢性溃疡性结肠炎，因腹痛和腹泻开始使用鸦片酊治疗后，出现了对鸦片及后来的丁丙诺啡的阿片类药物成瘾。除了对溃疡性结肠炎进行诊断和治疗外，还进行了戒毒治疗。在停用丁丙诺啡期间，腹泻略有增加。对于其他治疗无效的腹泻，应使用洛哌丁胺治疗，因为它对中枢神经系统没有影响。在炎症性肠病的慢性腹痛或肌肉骨骼疼痛中，如果无法通过手术或其他药物缓解疼痛，可以使用阿片类药物。必须对阿片类药物治疗的疗效和副作用进行持续监测，尤其是对阿片类药物滥用的监测。已发表的关于阿片类药物成瘾治疗诱导的病例报告表明，精神疾病合并症是一个重要甚至必要的风险因素。本文给出了一份在阿片类药物治疗期间阿片类药物成瘾的七个标准清单。
