Davis Mellar P
Cleveland Clinic Lerner School of Medicine at Case Western University, OH 44195, USA.
J Support Oncol. 2012 Nov-Dec;10(6):209-19. doi: 10.1016/j.suponc.2012.05.002. Epub 2012 Jul 17.
Buprenorphine is an opioid that has a complex and unique pharmacology which provides some advantages over other potent mu agonists. We review 12 reasons for considering buprenorphine as a frontline analgesic for moderate to severe pain: (1) Buprenorphine is effective in cancer pain; (2) buprenorphine is effective in treating neuropathic pain; (3) buprenorphine treats a broader array of pain phenotypes than do certain potent mu agonists, is associated with less analgesic tolerance, and can be combined with other mu agonists; (4) buprenorphine produces less constipation than do certain other potent mu agonists, and does not adversely affect the sphincter of Oddi; (5) buprenorphine has a ceiling effect on respiratory depression but not analgesia; (6) buprenorphine causes less cognitive impairment than do certain other opioids; (7) buprenorphine is not immunosuppressive like morphine and fentanyl; (8) buprenorphine does not adversely affect the hypothalamic-pituitary-adrenal axis or cause hypogonadism; (9) buprenorphine does not significantly prolong the QTc interval, and is associated with less sudden death than is methadone; (10) buprenorphine is a safe and effective analgesic for the elderly; (11) buprenorphine is one of the safest opioids to use in patients in renal failure and those on dialysis; and (12) withdrawal symptoms are milder and drug dependence is less with buprenorphine. In light of evidence for efficacy, safety, versatility, and cost, buprenorphine should be considered as a first-line analgesic.
丁丙诺啡是一种阿片类药物，其药理学特性复杂且独特，相较于其他强效μ阿片受体激动剂具有一些优势。我们综述了将丁丙诺啡视为中度至重度疼痛一线镇痛药的12个理由：（1）丁丙诺啡对癌痛有效；（2）丁丙诺啡对治疗神经性疼痛有效；（3）与某些强效μ阿片受体激动剂相比，丁丙诺啡能治疗更广泛的疼痛表型，镇痛耐受性较低，且可与其他μ阿片受体激动剂联合使用；（4）与某些其他强效μ阿片受体激动剂相比，丁丙诺啡引起的便秘较少，且对Oddi括约肌无不良影响；（5）丁丙诺啡对呼吸抑制有封顶效应，但对镇痛无此效应；（6）与某些其他阿片类药物相比，丁丙诺啡引起的认知障碍较少；（7）丁丙诺啡不像吗啡和芬太尼那样具有免疫抑制作用；（8）丁丙诺啡不会对下丘脑-垂体-肾上腺轴产生不良影响，也不会导致性腺功能减退；（9）丁丙诺啡不会显著延长QTc间期，与美沙酮相比，猝死风险较低；（10）丁丙诺啡对老年人是一种安全有效的镇痛药；（11）丁丙诺啡是肾衰竭患者和透析患者使用的最安全的阿片类药物之一；（12）丁丙诺啡的戒断症状较轻，药物依赖性较小。鉴于丁丙诺啡在疗效、安全性、多功能性和成本方面的证据，应将其视为一线镇痛药。
