Gordon Alan L, Connolly Seamus L
Chief of Clinical Addiction Services, Butler Hospital; Clinical Associate Professor of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI.
Resident of Psychiatry, Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA.
R I Med J (2013). 2017 Oct 2;100(10):41-44.
The CDC Guideline for Prescribing Opioids for Chronic Pain, published last March, provided major steps toward bringing the medical community together to address the opioid epidemic in the U.S. However, the Guideline focuses primarily on treatment of new inductions into opioid therapy for pain. Physicians may have difficulty figuring out how to apply the CDC's recommendations to patients who are already receiving opioid maintenance therapy for chronic pain. Patients already maintained on opioids for chronic pain should not be subjected to abrupt cessation or rapid tapers, and the CDC's Guideline confirms this. Physicians should not balk from treating opioid-dependent patients with chronic pain, and the CDC's recommendations do contain helpful information if one reads through them carefully. This article attempts to distill the major points from the Guideline for the treatment of chronic-pain patients already on long-term opioid therapy.[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].
美国疾病控制与预防中心（CDC）去年3月发布的《慢性疼痛患者阿片类药物处方指南》朝着让医学界团结起来应对美国阿片类药物泛滥问题迈出了重要步伐。然而，该指南主要关注的是针对新开始接受阿片类药物治疗疼痛的患者的治疗。医生可能难以弄清楚如何将CDC的建议应用于已经在接受慢性疼痛阿片类药物维持治疗的患者。已经因慢性疼痛接受阿片类药物维持治疗的患者不应突然停药或快速减量，CDC的指南也证实了这一点。医生不应回避治疗患有慢性疼痛的阿片类药物依赖患者，而且如果仔细研读，CDC的建议确实包含有用信息。本文试图提炼该指南中针对已经接受长期阿片类药物治疗的慢性疼痛患者的治疗要点。[全文可在http://rimed.org/rimedicaljournal-2017-10.asp获取]
