Department of Rheumatology and Immunology, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA.
Postgrad Med. 2010 Nov;122(6):87-97. doi: 10.3810/pgm.2010.11.2226.
Chronic low back pain (CLBP) and osteoarthritis (OA) of any joint are highly prevalent, occurring in > 50% of US adults aged ≥ 60 years. Opioids are prescribed more frequently for CLBP and OA than for any other noncancer pain, and the judicious use of opioids is recommended by treatment guidelines for the management of CLBP and OA pain.
To review the appropriate role of opioid analgesics in the treatment of patients with moderate-to-severe pain due to CLBP or OA and provide recommendations for best practices when prescribing opioids.
Articles were identified through a search of PubMed. Additional references were identified for inclusion from the reference lists of articles identified via the literature search, treatment guidelines, and Cochrane Reviews.
The available data suggest that opioid therapy represents a valuable treatment option in patients who do not respond to other analgesics and in whom the potential benefits of treatment outweigh the potential risks. Prescribing physicians need to perform vigilant patient screening and monitoring for signs of abuse, intervene promptly to manage or prevent adverse events and drug interactions, tailor opioid therapy to individual patients' comorbidities, and know how to switch or rotate opioids to find the best treatment option.
Prescribers need to understand the place of opioid therapy in a multimodal treatment program that includes patient rehabilitation to reduce pain and improve function. The analgesic benefits of opioids must be balanced against concerns about addiction and abuse, adverse events, and their potential impact on other aspects of treatment.
慢性下背痛（CLBP）和任何关节的骨关节炎（OA）的患病率都很高，超过 50%的美国≥60 岁成年人患有这些疾病。与任何其他非癌症疼痛相比，阿片类药物更常被用于治疗 CLBP 和 OA，并且治疗指南建议谨慎使用阿片类药物来治疗 CLBP 和 OA 疼痛。
回顾阿片类镇痛药在治疗 CLBP 或 OA 引起的中重度疼痛患者中的适当作用，并为阿片类药物处方提供最佳实践建议。
通过在 PubMed 中进行搜索来确定文章。从通过文献检索、治疗指南和 Cochrane 综述确定的文章的参考文献列表中确定了其他参考文献以供纳入。
现有数据表明，对于对其他镇痛药无反应且治疗的潜在益处超过潜在风险的患者，阿片类药物治疗代表了一种有价值的治疗选择。开处方的医生需要对患者进行仔细的筛查和监测，以发现滥用迹象，及时干预以管理或预防不良事件和药物相互作用，根据患者的合并症调整阿片类药物治疗，并了解如何切换或轮换阿片类药物以找到最佳治疗选择。
开处方的医生需要了解阿片类药物治疗在包括患者康复在内的多模式治疗方案中的作用，以减轻疼痛和改善功能。必须权衡阿片类药物的镇痛益处与成瘾和滥用、不良事件及其对治疗其他方面的潜在影响相关的担忧。
