Benyamin Ramsin, Trescot Andrea M, Datta Sukdeb, Buenaventura Ricardo, Adlaka Rajive, Sehgal Nalini, Glaser Scott E, Vallejo Ricardo
Millennium Pain Center, Bloomington, IL 61701, USA.
Pain Physician. 2008 Mar;11(2 Suppl):S105-20.
Medications which bind to opioid receptors are increasingly being prescribed for the treatment of multiple and diverse chronic painful conditions. Their use for acute pain or terminal pain is well accepted. Their role in the long-term treatment of chronic noncancer pain is, however, controversial for many reasons. One of the primary reasons is the well-known phenomenon of psychological addiction that can occur with the use of these medications. Abuse and diversion of these medications is a growing problem as the availability of these medications increases and this public health issue confounds their clinical utility. Also, the extent of their efficacy in the treatment of pain when utilized on a chronic basis has not been definitively proven. Lastly, the role of opioids in the treatment of chronic pain is also influenced by the fact that these potent analgesics are associated with a significant number of side effects and complications. It is these phenomena that are the focus of this review. Common side effects of opioid administration include sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression. Physical dependence and addiction are clinical concerns that may prevent proper prescribing and in turn inadequate pain management. Less common side effects may include delayed gastric emptying, hyperalgesia, immunologic and hormonal dysfunction, muscle rigidity, and myoclonus. The most common side effects of opioid usage are constipation (which has a very high incidence) and nausea. These 2 side effects can be difficult to manage and frequently tolerance to them does not develop; this is especially true for constipation. They may be severe enough to require opioid discontinuation, and contribute to under-dosing and inadequate analgesia. Several clinical trials are underway to identify adjunct therapies that may mitigate these side effects. Switching opioids and/or routes of administration may also provide benefits for patients. Proper patient screening, education, and preemptive treatment of potential side effects may aid in maximizing effectiveness while reducing the severity of side effects and adverse events. Opioids can be considered broad spectrum analgesic agents, affecting a wide number of organ systems and influencing a large number of body functions.
与阿片受体结合的药物越来越多地被用于治疗多种不同的慢性疼痛病症。它们用于急性疼痛或终末期疼痛已被广泛接受。然而，由于多种原因，它们在慢性非癌性疼痛的长期治疗中的作用存在争议。主要原因之一是使用这些药物可能会出现众所周知的心理成瘾现象。随着这些药物的可获得性增加，药物滥用和转移是一个日益严重的问题，这一公共卫生问题混淆了它们的临床效用。此外，长期使用这些药物时其治疗疼痛的疗效程度尚未得到明确证实。最后，阿片类药物在慢性疼痛治疗中的作用还受到这些强效镇痛药会引发大量副作用和并发症这一事实的影响。这些现象正是本综述的重点。阿片类药物给药的常见副作用包括镇静、头晕、恶心、呕吐、便秘、身体依赖性、耐受性和呼吸抑制。身体依赖性和成瘾是临床关注的问题，可能会妨碍正确用药，进而导致疼痛管理不足。不太常见的副作用可能包括胃排空延迟、痛觉过敏、免疫和激素功能障碍、肌肉僵硬和肌阵挛。阿片类药物使用最常见的副作用是便秘（发生率非常高）和恶心。这两种副作用可能难以处理，而且通常不会产生耐受性；便秘尤其如此。它们可能严重到需要停用阿片类药物，并导致用药不足和镇痛效果不佳。目前正在进行多项临床试验，以确定可能减轻这些副作用的辅助治疗方法。更换阿片类药物和/或给药途径也可能对患者有益。对患者进行适当的筛查、教育以及对潜在副作用进行预防性治疗，可能有助于在降低副作用和不良事件严重程度的同时最大化疗效。阿片类药物可被视为广谱镇痛药，会影响众多器官系统并影响大量身体功能。
