Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Pain Res Manag. 2010 Jul-Aug;15(4):213-7. doi: 10.1155/2010/867201.
The use of opioids for chronic noncancer pain (CNCP) remains controversial. Despite a number of randomized controlled trials showing efficacy and safety in the short term, long-term data are limited.
To survey a selected cohort of patients with intractable CNCP with regard to long-term efficacy and safety of opioids.
The present study reports long-term results from a survey of 84 patients with CNCP. The majority of patients had neuropathic pain, were treated with opioids and were followed every three months for a median of 8.4 years. Outcomes examined were pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life, immune status, sexual function, morbidity and mortality. Measures included a numerical rating scale, the Hospital Anxiety and Depression Scale, Brief Pain Inventory interference scale, Pain Disability Index and Short-Form Health Survey 12, version 2.
Both long- and short-acting opioids were reported to be effective, with few significant long-term adverse effects in many subjects in the present selected cohort. The majority of patients reported at least 50% or greater pain relief and a moderate improvement in disability. Functional status and health-related quality of life scores were not severely affected. Problematic opioid use, tolerance and serious adverse effects, including constipation, were not major issues. The authors emphasize that the results obtained in the present selected group may not be generalizable to all CNCP patients in whom opioids are being initiated.
阿片类药物用于慢性非癌性疼痛（CNCP）仍然存在争议。尽管许多随机对照试验显示短期疗效和安全性，但长期数据有限。
调查一组患有难治性 CNCP 的患者，了解阿片类药物的长期疗效和安全性。
本研究报告了对 84 例 CNCP 患者进行调查的长期结果。大多数患者患有神经性疼痛，接受阿片类药物治疗，并每三个月随访一次，中位数为 8.4 年。检查的结果包括疼痛严重程度、不良反应、疼痛缓解、满意度、情绪、阿片类药物使用问题、耐受性、身体依赖性、功能状态、健康相关生活质量、免疫状态、性功能、发病率和死亡率。评估方法包括数字评分量表、医院焦虑和抑郁量表、简明疼痛量表干扰量表、疼痛残疾指数和简短健康调查问卷 12 版。
在本研究的选定队列中，长效和短效阿片类药物均被报道有效，许多患者在长期内没有出现严重的不良反应。大多数患者报告疼痛缓解至少 50%或更多，残疾程度中度改善。功能状态和健康相关生活质量评分未受到严重影响。阿片类药物使用问题、耐受性和严重不良反应，包括便秘，不是主要问题。作者强调，在本研究的选定组中获得的结果可能不适用于所有开始使用阿片类药物的 CNCP 患者。
