Krashin Daniel, Murinova Natalia, Jumelle Patricia, Ballantyne Jane
University of Washington, Department of Psychiatry , Box 359896, 325 Ninth Ave, Seattle, WA 98104 , USA
Expert Opin Drug Saf. 2015 Jul;14(7):1023-33. doi: 10.1517/14740338.2015.1041915.
Pain management with opioids is a fundamental element of palliative medicine. Since the risks of chronic opioid therapy have emerged, a reassessment of these risks in the setting of palliative care is warranted.
This article presents information about opioid-related risks including i) sedation, cognitive impairment and falls; ii) constipation; iii) addiction to opioids and associated aberrant behavior; and iv) death due to respiratory depression. For this article, the medical literature was searched using PubMed and Web of Science for appropriate terms including 'palliative care' and 'opioid risk.' Medical subject headings were used to identify suitable articles including 'Analgesics, Opioid', 'Pain/drug therapy,' 'Palliative Care' and 'Hospice Care.' Further sources were identified by following cross-references within the literature and with the help of the University of Washington library staff.
Palliation of severe pain at the end of life is probably the most widely accepted indication for chronic opioid therapy. At increased doses, adverse effects of opioids may limit or interfere with the benefits of treatment. Careful screening and follow-up will allow risk factors to be recognized and addressed when possible. The use of adjunctive treatments for pain may reduce opioid requirements and yield better outcomes.
使用阿片类药物进行疼痛管理是姑息医学的一个基本要素。自从慢性阿片类药物治疗的风险出现以来，有必要在姑息治疗背景下对这些风险进行重新评估。
本文介绍了与阿片类药物相关的风险信息，包括：i）镇静、认知障碍和跌倒；ii）便秘；iii）阿片类药物成瘾及相关异常行为；iv）呼吸抑制导致的死亡。在撰写本文时，通过PubMed和Web of Science检索医学文献，使用了包括“姑息治疗”和“阿片类药物风险”等适当术语。医学主题词用于识别合适的文章，包括“镇痛药，阿片类”、“疼痛/药物疗法”、“姑息治疗”和“临终关怀”。通过遵循文献中的交叉引用并在华盛顿大学图书馆工作人员的帮助下确定了更多来源。
缓解临终时的剧痛可能是慢性阿片类药物治疗最广泛接受的适应症。随着剂量增加，阿片类药物的不良反应可能会限制或干扰治疗益处。仔细筛查和随访将有助于识别风险因素并在可能时加以解决。使用辅助性疼痛治疗可能会减少阿片类药物的需求并产生更好的效果。
