Galvez Rafael
Pain and Palliative Care Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.
J Pain Palliat Care Pharmacother. 2009;23(4):346-56. doi: 10.3109/15360280903323665.
According to the 2005 Pain in Europe Survey, the use of opioids to treat patients with chronic noncancer pain varies considerably among different countries in Europe. Undertreatment of chronic pain is common. This review examines the possible causes and consequences of limiting opioid availability to these patients. The causes of inadequate opioid use include medical, ethical, and cultural factors that influence prescribing decisions; legislative and health care system controls that serve to restrict the use of opioids for long-term treatment of non-cancer-related pain conditions; and poor treatment acceptance by patients. The validity of these restrictions is discussed in relation to the need to protect patients and society from harm due to adverse events, and the potential for misuse and abuse with prescribed opioids. This is balanced against the therapeutic goal of providing the best available pain-relieving treatment and to avoid the consequences of unnecessary suffering in patients with chronic noncancer pain.
根据2005年欧洲疼痛调查，欧洲不同国家在使用阿片类药物治疗慢性非癌性疼痛患者方面存在很大差异。慢性疼痛治疗不足很常见。本综述探讨了限制这些患者获得阿片类药物的可能原因及后果。阿片类药物使用不足的原因包括影响处方决策的医学、伦理和文化因素；旨在限制阿片类药物用于非癌症相关疼痛长期治疗的立法和医疗保健系统控制措施；以及患者对治疗的接受度低。讨论了这些限制措施的合理性，涉及保护患者和社会免受不良事件伤害的必要性，以及处方阿片类药物被误用和滥用的可能性。这与提供最佳可用止痛治疗的治疗目标以及避免慢性非癌性疼痛患者不必要痛苦的后果相权衡。
