Adriaensen H, Vissers K, Noorduin H, Meert T
Department of Anesthesiology, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium.
Acta Anaesthesiol Belg. 2003;54(1):37-47.
Although opioids provide effective analgesia, largely unsubstantiated concerns about opioid-induced tolerance, physical dependence and addiction have limited their appropriate use. As a consequence, many patients receive inadequate treatment for both malignant and non-malignant pain. However, it has been shown that analgesic tolerance develops less frequently during chronic opioid administration in a clinical context than in animal experiments, and that instituting an appropriate dosing regimen can minimise withdrawal symptoms. Early studies had suggested that addiction might result from chronic opioid therapy, though more recent data indicate a low risk in patients with no history of drug abuse. New treatment regimens may also reduce the risk of tolerance, physical dependence and addiction. Long-acting preparations, such as transdermal fentanyl and possibly some forms of other slow release opioids, which maintain constant opioid concentrations in the plasma, minimise the occurrence of the 'between-dose' symptoms such as withdrawal and opioid-induced euphoria. This review discusses the development of tolerance, physical dependence and addiction during opioid therapy, and the influence of these factors on the choice of treatment.
尽管阿片类药物能提供有效的镇痛作用，但对阿片类药物引起耐受性、身体依赖性和成瘾性的诸多未经证实的担忧限制了其合理使用。因此，许多患者的恶性和非恶性疼痛都未得到充分治疗。然而，研究表明，与动物实验相比，临床环境中慢性阿片类药物给药期间镇痛耐受性的发生频率较低，并且采用适当的给药方案可将戒断症状降至最低。早期研究曾表明成瘾可能是慢性阿片类药物治疗的结果，不过最近的数据表明，无药物滥用史的患者成瘾风险较低。新的治疗方案也可能降低耐受性、身体依赖性和成瘾性的风险。长效制剂，如透皮芬太尼以及可能的某些其他缓释阿片类药物剂型，可使血浆中的阿片类药物浓度保持恒定，将“剂量间隔期”症状（如戒断和阿片类药物引起的欣快感）的发生降至最低。本综述讨论了阿片类药物治疗期间耐受性、身体依赖性和成瘾性的发展，以及这些因素对治疗选择的影响。
