Schneider Jennifer P
Geriatrics. 2005 May;60(5):26-8, 30-1.
Chronic non-cancer pain is notoriously undertreated, especially when the source cannot be identified by objective testing. Effective treatment often requires a combination of pharmacologic and non-pharmacologic approaches. This article describes current medication management of chronic pain, with particular attention to opioids. Acetaminophen and anti-inflammatories are first-line drugs for mild to moderate pain. For neuropathic pain, anticonvulsants are finding an increasing role, as are topical agents. Antidepressants are often advisable. Regarding opioids, the article addresses concerns about addiction potential; distinguishes between addiction and physical dependency; details the role of tolerance to different effects of opioids; and discusses their safety. With appropriate dosing, vigilant management, and careful tapering, opioids are a safe and effective choice for pain management in older adults. Appropriate follow-up guidelines are presented.
慢性非癌性疼痛的治疗一直很不足，尤其是在无法通过客观检测确定疼痛根源时。有效的治疗通常需要药物和非药物方法相结合。本文介绍了慢性疼痛的当前药物管理，特别关注阿片类药物。对乙酰氨基酚和抗炎药是轻至中度疼痛的一线药物。对于神经性疼痛，抗惊厥药的作用越来越大，局部用药也是如此。通常建议使用抗抑郁药。关于阿片类药物，本文讨论了对成瘾可能性的担忧；区分了成瘾和身体依赖；详述了对阿片类药物不同作用的耐受性的作用；并讨论了它们的安全性。通过适当的给药、警惕的管理和谨慎的逐渐减量，阿片类药物是老年人疼痛管理的安全有效选择。本文还提出了适当的随访指南。
