1Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina 2Department of Orthopaedic Surgery, University of Texas at Austin, Austin, Texas 3Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
J Bone Joint Surg Am. 2017 Nov 1;99(21):e113. doi: 10.2106/JBJS.17.00066.
In the past 2 decades, overdoses and deaths from prescription opioids have reached epidemic proportions in the United States. The widespread use of opioids complicates management of the orthopaedic surgery patient in the acute and chronic settings. Orthopaedic surgeons are some of the top prescribers of opioids in the complex setting of chronic use, abuse, and diversion.
The literature regarding the basic science of pharmacologic options for pain management (e.g., opioids and nonsteroidal anti-inflammatory drugs), the impact of strategies on bone and soft-tissue healing, and pain relief are summarized as they relate to the management of orthopaedic injuries and conditions. Additionally, a section on designing solutions to address the current opioid crisis is presented.
The mechanism of action of different classes of analgesic medications is discussed, as well as the basic scientific evidence regarding the impact of narcotic and nonnarcotic analgesic medications on bone-healing and on other organ systems. Differences between pain and nociception, various treatment strategies, and clinical comparisons of the effectiveness of various analgesics compared with opioids are summarized. Finally, options for addressing the opioid crisis, including the description of a large system-wide intervention to impact prescriber behavior at the point of care using health-information solutions, are presented.
Orthopaedic leaders, armed with information and strategies, can help lead the way to solutions to the opioid epidemic in their respective communities, institutions, and subspecialty societies. Through leadership and education, orthopaedic surgeons can help shape the solution for this critical public health issue.
在过去的 20 年中，美国的处方类阿片类药物过量和死亡人数已达到流行程度。阿片类药物的广泛使用使骨科手术患者在急性和慢性环境中的管理变得复杂。在慢性使用、滥用和转移的复杂环境中，骨科医生是开具阿片类药物处方最多的医生之一。
本文总结了与骨科损伤和疾病管理相关的疼痛管理药物选择（例如阿片类药物和非甾体抗炎药）的药理学基本原理、策略对骨骼和软组织愈合的影响以及疼痛缓解的基本科学知识。此外，还介绍了一个解决当前阿片类药物危机的解决方案设计部分。
讨论了不同类别的镇痛药物的作用机制，以及关于麻醉性和非麻醉性镇痛药对骨骼愈合和其他器官系统的影响的基本科学证据。总结了疼痛和伤害感受之间的差异、各种治疗策略以及与阿片类药物相比各种镇痛药的临床比较。最后，提出了解决阿片类药物危机的选择，包括描述一种利用健康信息解决方案在医疗点影响处方行为的大型系统范围干预措施。
掌握了信息和策略的骨科领导者，可以帮助在各自的社区、机构和专科协会中找到解决阿片类药物流行的方法。通过领导和教育，骨科医生可以帮助解决这一关键的公共卫生问题。
