Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA.
Best Pract Res Clin Rheumatol. 2013 Oct;27(5):663-72. doi: 10.1016/j.berh.2013.09.011. Epub 2013 Oct 5.
Increased opioid prescribing for back pain and other chronic musculoskeletal pain conditions has been accompanied by dramatic increases in prescription-opioid addiction and fatal overdose. Opioid-related risks appear to increase with dose. Although short-term randomised trials of opioids for chronic pain have found modest analgesic benefits (a one-third reduction in pain intensity on average), the long-term safety and effectiveness of opioids for chronic musculoskeletal pain remains unknown. Given the lack of large, long-term randomised trials, recent epidemiologic data suggest the need for caution when considering long-term use of opioids to manage chronic musculoskeletal pain, particularly at higher dosage levels. Principles for achieving more selective and cautious use of opioids for chronic musculoskeletal pain are proposed.
阿片类药物处方用于治疗背痛和其他慢性肌肉骨骼疼痛疾病的情况增多，随之而来的是阿片类药物成瘾和致命过量用药的显著增加。阿片类药物相关风险似乎随着剂量的增加而增加。虽然短期随机对照试验发现阿片类药物治疗慢性疼痛具有适度的镇痛益处（平均疼痛强度降低三分之一），但长期使用阿片类药物治疗慢性肌肉骨骼疼痛的安全性和有效性仍不清楚。鉴于缺乏大型长期随机对照试验，最近的流行病学数据表明，在考虑长期使用阿片类药物治疗慢性肌肉骨骼疼痛时，特别是在较高剂量水平时，需要谨慎。本文提出了用于慢性肌肉骨骼疼痛的阿片类药物更具选择性和更谨慎使用的原则。
