Provenzano David A, Viscusi Eugene R
Edgeworth Medical Commons , Sewickley, PA , USA.
Curr Med Res Opin. 2014 Oct;30(10):2051-62. doi: 10.1185/03007995.2014.921610. Epub 2014 Jun 18.
Opioid analgesics are commonly and increasingly prescribed by physicians for the management of chronic pain. However, strong evidence supports the need for strategies that reduce opioid use. The objective of this review is to outline limitations associated with opioid use and discuss therapeutic techniques that can be adopted to optimize the use of opioids in the management of chronic nonmalignant pain.
Literature searches through MEDLINE and Cochrane databases were used to identify relevant journal articles. The search was limited to articles published from January 1980 to January 2014. Additional references were obtained from articles extracted during the database search. Relevant search terms included opioid, opioid abuse, chronic pain management, written care agreements, urine drug testing, and multimodal therapy.
Opioids exhibit a well established abuse potential and evidence supporting the efficacy of opioids in chronic pain management is limited. In addition, opioid exposure is associated with adverse effects on multiple organ systems. Effective strategies designed to mitigate opioid abuse and diversion and optimize clinical outcomes should be employed.
Appropriate patient selection through identification of risk factors, urine drug testing, and access to prescription monitoring programs has been shown to effectively improve care. Structured opioid therapy in a multimodal platform, including use of a low initial dose, prescription of alternative non-opioid analgesics including non-steroidal anti-inflammatory drugs and acetaminophen, as well as development of written care agreements to individualize and guide therapy has also been shown to improve patient outcomes. Implementation of opioid allocation strategies has the potential to encourage appropriate opioid use and improve patient care.
医生越来越普遍地开具阿片类镇痛药用于慢性疼痛的管理。然而，有力证据支持需要采取减少阿片类药物使用的策略。本综述的目的是概述与阿片类药物使用相关的局限性，并讨论可采用的治疗技术，以优化阿片类药物在慢性非恶性疼痛管理中的使用。
通过MEDLINE和Cochrane数据库进行文献检索，以识别相关的期刊文章。检索限于1980年1月至2014年1月发表的文章。其他参考文献来自数据库检索过程中提取的文章。相关检索词包括阿片类药物、阿片类药物滥用、慢性疼痛管理、书面护理协议、尿液药物检测和多模式治疗。
阿片类药物具有公认的滥用可能性，支持其在慢性疼痛管理中疗效的证据有限。此外，阿片类药物暴露与对多个器官系统的不良反应相关。应采用旨在减轻阿片类药物滥用和转移并优化临床结果的有效策略。
通过识别风险因素、尿液药物检测和使用处方监测程序进行适当的患者选择已被证明可有效改善护理。在多模式平台上进行结构化阿片类药物治疗，包括使用低初始剂量、开具替代非阿片类镇痛药（包括非甾体抗炎药和对乙酰氨基酚），以及制定书面护理协议以个性化和指导治疗，也已被证明可改善患者预后。实施阿片类药物分配策略有可能鼓励适当使用阿片类药物并改善患者护理。
