Hsu Eric S
Comprehensive Pain Center, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Curr Pain Headache Rep. 2017 Jan;21(1):2. doi: 10.1007/s11916-017-0606-z.
Chronic pain is usually managed by various pharmacotherapies after exhausting the conservative modalities such as over-the-counter choices. The goal of this review is to investigate current state of opioids and non-opioid medication overuse that includes NSAIDs, skeletal muscle relaxants, antidepressants, membrane stabilization agents, and benzodiazepine. How to minimize medication overuse and achieve better outcome in chronic pain management?
Although antidepressants and membrane stabilization agents contribute to the crucial components for neuromodulation, opioids were frequently designated as a rescue remedy in chronic pain since adjunct analgesics usually do not provide instantaneous relief. The updated CDC guideline for prescribing opioids has gained widespread attention via media exposure. Both patients and prescribers are alerted to respond to the opioid epidemic and numerous complications. However, there has been overuse of non-opioid adjunct analgesics that caused significant adverse effects in addition to concurrent opioid consumption. It is a common practice to extrapolate the WHO three-step analgesic ladder for cancer pain to apply in non-cancer pain that emphasizes solely on pharmacologic therapy which may result in overuse and escalation of opioids in non-cancer pain. There has been promising progress in non-pharmacologic therapies such as biofeedback, complementary, and alternative medicine to facilitate pain control instead of dependency on pharmacologic therapies. This review article presents the current state of medication overuse in chronic pain and proposes precaution to balance the risk and benefit ratio. It may serve as a premier for future study on clinical pathway for comprehensive chronic pain management and reduce medication overuse.
在诸如非处方药物等保守治疗方式用尽后，慢性疼痛通常通过各种药物疗法进行管理。本综述的目的是调查阿片类药物和非阿片类药物过度使用的现状，其中包括非甾体抗炎药、骨骼肌松弛剂、抗抑郁药、膜稳定剂和苯二氮䓬类药物。如何在慢性疼痛管理中尽量减少药物过度使用并取得更好的效果？
尽管抗抑郁药和膜稳定剂是神经调节的关键组成部分，但由于辅助镇痛药通常不能提供即时缓解，阿片类药物在慢性疼痛中常被用作急救药物。疾病控制与预防中心（CDC）最新的阿片类药物处方指南通过媒体曝光获得了广泛关注。患者和开处方者都被提醒要应对阿片类药物流行及其众多并发症。然而，除了同时使用阿片类药物外，非阿片类辅助镇痛药也存在过度使用的情况，这会导致严重的不良反应。将世界卫生组织针对癌症疼痛的三阶梯镇痛法外推应用于非癌症疼痛是一种常见做法，这种方法仅强调药物治疗，这可能导致非癌症疼痛中阿片类药物的过度使用和升级。在生物反馈、补充和替代医学等非药物疗法方面已经取得了有前景的进展，这些疗法有助于控制疼痛，而不是依赖药物治疗。本文综述介绍了慢性疼痛中药物过度使用的现状，并提出了平衡风险和效益比的预防措施。它可为未来关于慢性疼痛综合管理临床路径及减少药物过度使用的研究提供初步参考。
