Tournebize Juliana, Gibaja Valérie, Muszczak Amandine, Kahn Jean-Pierre
Centre for Evaluation and Information on Pharmacodependence-Addictovigilance, 'Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance' (CEIP-A), Nancy University Medical Center, Nancy, France.
Department of Psychiatry and Clinical Psychology, Nancy University Medical Center, Université de Lorraine, Lorraine, France.
Pain Pract. 2016 Mar;16(3):370-83. doi: 10.1111/papr.12289. Epub 2015 Apr 10.
With rising prescription of opioid medications for chronic noncancer pain (CNCP) in the past years, opioid abuse and overdose deaths have increased in parallel. To ensure adequate treatment outcomes and reduce the risks linked with the chronic use of opioids, practitioner's adherence to treatment guidelines is essential. This study summarizes published recommendations about the strategies to reduce the risks associated with the chronic use of opioids and evaluates the adherence of physicians to these recommendations.
A systematic literature search was undertaken in May 2014 using major databases. Studies were included if they examined the adherence of practitioners with at least one form of opioid risk reduction strategy. Benchmark guidelines cited in these studies were also reviewed.
The search yielded 683 records, 14 of which were found to evaluate adherence of physicians to opioid risk reduction strategies. Nine benchmark guidelines were found. Almost all physicians consider opioid therapy only when other safer approaches have failed and do not prescribe opioids at doses greater than 200 mg/day of morphine equivalent. Unfortunately, less than 50% assess pain intensity using a pain scale; they often consider transdermal fentanyl safe for opioid-naïve patients and fail to discontinue opioids if they were ineffective in relieving patients' pain.
Substantial practice and knowledge gaps were identified, including the use of pain scales and prescription of transdermal fentanyl in opioid-naïve patients, which have important implications for patient's safety. Guidelines more practical to physicians' settings and further education of physicians are warranted.
在过去几年中，随着用于慢性非癌性疼痛（CNCP）的阿片类药物处方量的增加，阿片类药物滥用和过量死亡人数也随之上升。为确保获得足够的治疗效果并降低与长期使用阿片类药物相关的风险，从业者遵守治疗指南至关重要。本研究总结了已发表的关于降低长期使用阿片类药物相关风险的策略的建议，并评估了医生对这些建议的遵守情况。
2014年5月使用主要数据库进行了系统的文献检索。如果研究考察了从业者对至少一种降低阿片类药物风险策略的遵守情况，则纳入该研究。还对这些研究中引用的基准指南进行了审查。
检索得到683条记录，其中14条被发现用于评估医生对降低阿片类药物风险策略的遵守情况。共找到九条基准指南。几乎所有医生仅在其他更安全的方法均无效时才考虑使用阿片类药物治疗，且不会开具剂量超过每日200毫克吗啡当量的阿片类药物。遗憾的是，不到50%的医生使用疼痛量表评估疼痛强度；他们通常认为透皮芬太尼对未使用过阿片类药物的患者是安全的，并且如果阿片类药物在缓解患者疼痛方面无效时，他们不会停用。
发现了大量的实践和知识差距，包括在未使用过阿片类药物的患者中使用疼痛量表和开具透皮芬太尼处方，这对患者安全具有重要影响。有必要制定更适合医生实际情况的指南并对医生进行进一步教育。
