Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
Br J Clin Pharmacol. 2013 Jan;75(1):60-78. doi: 10.1111/j.1365-2125.2012.04317.x.
Clinical studies comparing the response and side effects of various opioids have not been able to show robust differences between drugs. Hence, recommendations of the regulatory authorities have been driven by costs with a general tendency in many countries to restrict physician's use of opioids to morphine. Although this approach is recognized as cost-effective in most cases there is solid evidence that, on an individual patient basis, opioids are not all equal. Therefore it is important to have an armamentarium of strong analgesics in clinical practice to ensure a personalized approach in patients who do not respond to standard treatment. In this review we highlight differences between opioids in human studies from a pharmacological, experimental, clinical and health economics point of view. We provide evidence that individuals respond differently to opioids, and that general differences between classes of opioids exist. We recommend that this recognition is used to individualize treatment in difficult cases allowing physicians to have a wide range of treatment options. In the end this will reduce pain and side effects, leading to improved quality of life for the patient and reduce the exploding pain related costs.
临床研究比较了各种阿片类药物的反应和副作用，但未能显示出药物之间的明显差异。因此，监管机构的建议是基于成本的，许多国家普遍倾向于限制医生使用阿片类药物，只限于使用吗啡。尽管这种方法在大多数情况下是具有成本效益的，但有确凿的证据表明，就个体患者而言，阿片类药物并不完全相同。因此，在临床实践中拥有一套强有力的镇痛药物非常重要，以确保对标准治疗无反应的患者能够采取个性化的治疗方法。在这篇综述中，我们从药理学、实验、临床和健康经济学的角度强调了人类研究中阿片类药物之间的差异。我们提供的证据表明，个体对阿片类药物的反应不同，而且阿片类药物的类别之间存在一般差异。我们建议，在困难情况下应根据这种认识进行个体化治疗，允许医生有广泛的治疗选择。最终，这将减轻疼痛和副作用，提高患者的生活质量，并降低与疼痛相关的不断膨胀的成本。
