Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
Pain. 2013 Dec;154 Suppl 1(0 1):S94-S100. doi: 10.1016/j.pain.2013.09.009. Epub 2013 Sep 11.
Opioid therapy offers the promise of reducing the burden of chronic pain in not just individual patients, but among the broad population of patients with chronic pain. Randomized trials have demonstrated that opioid therapy for up to 12-16weeks is superior to placebo, but have not addressed longer-term use. In the United States, opioid sales have quadrupled during 2000-2010, with parallel increases in opioid accidental overdose deaths and substance abuse admissions. Clinical use of long-term opioid therapy is characterized by a pattern of adverse selection, where high-risk patients are prescribed high-risk opioid regimens. This adverse selection may link these trends in use, abuse, and overdose. Long-term opioid therapy appears to be associated with iatrogenic harm to the patients who receive the prescriptions and to the general population. The United States has, in effect, conducted an experiment of population-wide treatment of chronic pain with long-term opioid therapy. The population-wide benefits have been hard to demonstrate, but the harms are now well demonstrated.
阿片类药物疗法有望减轻慢性疼痛患者的负担，不仅是个体患者，而且是广大慢性疼痛患者群体。随机试验已经证明，阿片类药物疗法长达 12-16 周优于安慰剂，但尚未解决长期使用的问题。在美国，2000 年至 2010 年期间，阿片类药物的销售额增长了两倍，阿片类药物意外过量死亡和药物滥用入院人数也相应增加。长期阿片类药物疗法的临床应用特点是不良选择，高风险患者被开处高风险的阿片类药物治疗方案。这种不良选择可能与这些使用、滥用和过量趋势有关。长期阿片类药物疗法似乎会对接受处方的患者和一般人群造成医源性伤害。美国实际上已经对慢性疼痛的长期阿片类药物疗法进行了全人群治疗实验。全人群的获益很难证明，但危害现在已经很明显。
