Pain Management Centre, Singapore General Hospital, Outram Road, Singapore 169608.
Singapore Med J. 2013 Sep;54(9):506-10. doi: 10.11622/smedj.2013173.
The use of opioids in chronic non-cancer pain (CNCP) is controversial, as it presents both benefits and risks. There is currently no available data on the incidence, prescription pattern, functional outcomes and adverse effects of opioids in patients with CNCP in Singapore. This study aimed to address the aforementioned deficit.
All records of patients who were prescribed strong opioids (for > 3 months per year) for the management of CNCP over a two-year period were retrospectively analysed. Factors including type of opioid, indications for opioid prescription, uncontrolled side effects, functional status, coexisting psychological issues and suspicion of aberrant drug-seeking behaviour were studied.
Out of the 1,389 new patients who visited the centre, 42 (3.0%) with CNCP received strong opioids for more than three months a year. The most commonly prescribed opioid was methadone (42.9%). The principal diagnosis for opioid prescription was spinal pain (38.1%). Ten patients had severe side effects. 15 patients saw improvement in activities of daily living scores. Although ten patients returned to work, one stopped following the commencement of opioids. Aberrancy was seen in 5 (11.9%) patients, while 19 (45.2%) had psychological issues and 10 (23.8%) required psychiatric co-management.
Opioids are not a panacea for chronic pain. Therefore, functional outcomes should be considered more important end points than mere reductions in pain scores. A multidisciplinary team approach is essential for the effective management of patients with CNCP who are on opioids.
在慢性非癌痛（CNCP）中使用阿片类药物存在争议，因为它既有好处也有风险。目前，新加坡还没有关于 CNCP 患者使用阿片类药物的发病率、处方模式、功能结果和不良反应的可用数据。本研究旨在解决上述缺陷。
回顾性分析了两年期间因管理 CNCP 而开具强阿片类药物（每年>3 个月）的所有患者的记录。研究的因素包括阿片类药物的类型、阿片类药物处方的适应症、无法控制的副作用、功能状态、共存的心理问题和异常药物寻求行为的嫌疑。
在 1389 名新就诊的患者中，有 42 名（3.0%）患有 CNCP，他们每年接受强阿片类药物治疗超过 3 个月。最常开的阿片类药物是美沙酮（42.9%）。开阿片类药物的主要诊断是脊柱疼痛（38.1%）。10 名患者出现严重副作用。15 名患者日常生活活动评分有所改善。尽管有 10 名患者恢复工作，但有 1 名患者在开始使用阿片类药物后停止工作。5 名（11.9%）患者出现异常，19 名（45.2%）患者存在心理问题，10 名（23.8%）患者需要精神科共同管理。
阿片类药物并不是慢性疼痛的万灵药。因此，功能结果应该比单纯的疼痛评分降低更重要的终点。对于接受阿片类药物治疗的 CNCP 患者，多学科团队方法是有效管理的关键。
