University of Toronto, Toronto, Ontario, Canada.
Pain Res Manag. 2012 Jul-Aug;17(4):263-75. doi: 10.1155/2012/495781.
The use of opioids for chronic noncancer pain (CNCP) remains very controversial. There are several randomized controlled trials, mostly in neuropathic pain, reporting efficacy and safety in the short term, but more long-term data are needed. Randomized controlled trials may be limited in providing data about the patients who benefit from often high-dose opioids over the long term. The present article provides details of these patients and adds to a previous case series.
The present article contains 17 case reports of 11 CNCP conditions (followed to 2011) selected to illustrate specific issues from a survey of 84 patients with intractable CNCP treated with opioids and followed every three months for a median of 11 years. The previous published survey of this group reported outcomes of pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life (HRQL), immune status and sexual function. The outcome measures for that study included a numerical rating scale for pain, the Hospital Anxiety and Depression Scale, the Brief Pain Inventory Interference Scale, the Pain Disability Index and, for HRQL, the Short-Form Health Survey 12 version 2. Most patients in the total sample reported 50% or greater relief and a moderate improvement in disability. Scores for functional status and HRQL were not severely affected. Problematic use, tolerance and serious adverse effects, including constipation, were not major issues. These selected patient reports were chosen, not to illustrate optimal results, but rather important aspects of the diagnoses, opioids and doses, the paucity of intolerable adverse effects, particular issues (concurrent addiction history, bipolar disorder and combination therapy), disease-specific and other outcomes and duration of follow-up with complex pain problems.
Opioids were found to be safe and useful in the long term for these particular patients, as well as in the larger group from which they originated.
These 17 reports of patients with intractable CNCP treated with opioids with some success over many years puts a face on more of the participants in the larger survey of 84 subjects, suggesting that this approach is effective and safe for some patients over many years.
阿片类药物治疗慢性非癌痛（CNCP）仍然存在很大争议。有几项随机对照试验，主要针对神经病理性疼痛，报告了短期疗效和安全性，但需要更多的长期数据。随机对照试验可能在提供关于长期使用高剂量阿片类药物获益患者的数据方面存在局限性。本文详细介绍了这些患者的情况，并补充了之前的一系列病例。
本文包含 17 例 11 种 CNCP 疾病的病例报告（随访至 2011 年），这些病例是从 84 例接受阿片类药物治疗的难治性 CNCP 患者的调查中选择的，这些患者每三个月随访一次，中位随访时间为 11 年。之前发表的该组患者调查结果报告了疼痛严重程度、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（HRQL）、免疫状态和性功能等方面的结果。该研究的结局测量包括疼痛的数字评分量表、医院焦虑抑郁量表、简明疼痛干扰量表、疼痛残疾指数以及 HRQL 的简短健康调查 12 版本 2。在总样本中，大多数患者报告疼痛缓解 50%或以上，残疾程度中度改善。功能状态和 HRQL 的评分未受严重影响。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。选择这些患者报告不是为了说明最佳结果，而是为了说明诊断、阿片类药物和剂量、可耐受不良反应的缺乏、特殊问题（并发成瘾史、双相情感障碍和联合治疗）、疾病特异性和其他结局以及复杂疼痛问题的长期随访。
长期使用阿片类药物治疗这些特定患者，以及治疗来自更大样本的患者，被发现是安全有效的。
这些 17 例接受阿片类药物治疗的难治性 CNCP 患者的报告显示，他们在多年内取得了一定的成功，这让我们更了解更大样本 84 名患者调查中的更多参与者，表明这种方法对一些患者在多年内是有效且安全的。
