Chang Ku-Lang, Fillingim Roger, Hurley Robert W, Schmidt Siegfried
University of Florida Health Family Medicine - Hampton Oaks, 200 SW 62nd Blvd Suite D, Gainesville, FL 32608,
Clinical and Translational Research Building Room 3216, 2004 Mowry Road, Gainesville, FL 32610-0404,
FP Essent. 2015 May;432:27-38.
Clinicians should combine nonpharmacologic therapies and pharmacotherapy for management of chronic pain. Safety and effectiveness determine the choice of therapy. Typically, nonopioid analgesics are first-line treatment, including acetaminophen, nonsteroidal anti-inflammatory drugs, and topical drugs. A trial of an opioid, in combination with other modalities, should be considered if pain persists. Because of the potential for serious adverse effects, opioids should be prescribed only if the clinician is familiar with their use and associated risks. If pain is not controlled, consider pharmacogenetic effects or the addition of adjuvant therapy. In states with prescription drug monitoring programs, clinicians must access these programs regularly when prescribing a controlled substance. Consider performing pill counts and random urine drug screening for monitoring drug use. Adjuvant drugs to be considered include antidepressants, buspirone, anticonvulsants, muscle relaxants, onabotulinumtoxinA, clonidine, and corticosteroids, depending on type of pain and individual characteristics.
临床医生应将非药物疗法和药物疗法结合起来用于慢性疼痛的管理。安全性和有效性决定了治疗方法的选择。通常，非阿片类镇痛药是一线治疗药物，包括对乙酰氨基酚、非甾体抗炎药和外用药物。如果疼痛持续，应考虑试用阿片类药物并结合其他治疗方式。由于存在严重不良反应的可能性，仅当临床医生熟悉其用法及相关风险时才可开具阿片类药物。如果疼痛未得到控制，应考虑药物遗传学效应或加用辅助治疗。在设有处方药监测计划的州，临床医生在开具管制药品时必须定期查阅这些计划。考虑进行药丸计数和随机尿液药物筛查以监测药物使用情况。根据疼痛类型和个体特征，可考虑使用的辅助药物包括抗抑郁药、丁螺环酮、抗惊厥药、肌肉松弛剂、A型肉毒毒素、可乐定和皮质类固醇。
