Hampel C, Schenk M, Göbel H, Gralow I, Grüsser S M, Jellinek C, Ernst G, Hermanns K, Gölz J, Poser W, Strumpf M, Neugebauer E A M, Spies C
Klinik für Anästhesiologie und operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum/Charité Campus Mitte, Berlin.
Schmerz. 2006 Sep;20(5):445-57; quiz 458-9. doi: 10.1007/s00482-006-0491-6.
Each individual is entitled to an adequate and sufficient pain therapy. However, only a few studies have examined the peculiarities of pain management in drug-dependent or formerly addicted patients. Any addiction is disadvantageous for a successful pain therapy, since some of the prescribed drugs may themselves cause addiction. Drug-dependent patients are often tolerant to opioids. Additionally, there is a risk of iatrogenic pain becoming chronic due to disregard for already known risk factors and comorbidities. However, a history of addiction should not prevent sufficient pain therapy, especially since there is no risk of addiction when the pain therapy employed is adequate for the pathophysiology involved. There are adequate pain therapies for addicted patients. The best results are achieved by taking into account the physiological and psychological peculiarities of drug-dependent patients. Importantly, this should be combined with a variety of different, optimized, multimodal therapeutic regimes, as well as with an interdisciplinary approach.
每个人都有权获得充分且足够的疼痛治疗。然而,仅有少数研究探讨了药物依赖或曾成瘾患者疼痛管理的特殊性。任何成瘾情况都不利于成功进行疼痛治疗,因为一些开具的药物本身可能导致成瘾。药物依赖患者通常对阿片类药物产生耐受性。此外,由于忽视已知的风险因素和合并症,医源性疼痛有变为慢性的风险。然而,成瘾史不应妨碍充分的疼痛治疗,特别是因为当所采用的疼痛治疗适合所涉及的病理生理学时不存在成瘾风险。有成瘾患者适用的充分疼痛治疗方法。通过考虑药物依赖患者的生理和心理特殊性可取得最佳效果。重要的是,这应与各种不同的、优化的多模式治疗方案以及跨学科方法相结合。