阿片类镇痛药在老年疼痛管理中的作用。
The Role of Opioid Analgesics in Geriatric Pain Management.
作者信息
Naples Jennifer Greene, Gellad Walid F, Hanlon Joseph T
机构信息
Division of Geriatrics & Gerontology, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Medical Building Suite 500, Pittsburgh, PA 15213, USA.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA, USA; Division of General Medicine, Department of Medicine, University of Pittsburgh School of Medicine, University Drive (151C), Pittsburgh, PA 15240, USA.
出版信息
Clin Geriatr Med. 2016 Nov;32(4):725-735. doi: 10.1016/j.cger.2016.06.006. Epub 2016 Aug 9.
When possible, chronic noncancer pain (CNCP) in older adults should be managed by nonpharmacologic modalities in conjunction with nonopioid analgesics. If moderate-to-severe pain persists despite these approaches, however, nonparenteral opioids may be considered as adjunctive therapy. This article reviews the epidemiology of opioid use and their effectiveness for CNCP in older adults and summarizes important age-related changes in opioid pharmacokinetics and pharmacodynamics that increase the risks of adverse effects in the elderly. Finally, to assist clinicians with selecting appropriate therapy, the article concludes with an evidence-based approach to optimize opioid prescribing in older adults with CNCP.
如果可能的话，老年人的慢性非癌性疼痛（CNCP）应采用非药物治疗方法并结合非阿片类镇痛药进行管理。然而，如果尽管采取了这些方法，中度至重度疼痛仍然持续，非胃肠外阿片类药物可被视为辅助治疗。本文综述了阿片类药物在老年人中的使用流行病学及其对CNCP的有效性，并总结了与年龄相关的阿片类药物药代动力学和药效学的重要变化，这些变化增加了老年人不良反应的风险。最后，为了帮助临床医生选择合适的治疗方法，本文以基于证据的方法作为结尾，以优化患有CNCP的老年人的阿片类药物处方。
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