Department of Anesthesiology, Beth Israel Hospital, Harvard Medical School, Boston, MA, USA.
Department of Anesthesia, LSU Health Science Center, New Orleans, LA, USA.
Curr Pain Headache Rep. 2018 Feb 23;22(3):20. doi: 10.1007/s11916-018-0672-x.
The prevalence of chronic pain and prescription opioid abuse has resulted in epidemic problems for patients and clinicians. The consequences are taking a heavy toll on patients, physicians, and society. Specific to radiology, a significant need exists for best practice assessment and treatment approaches for pain management, as patients with chronic pain often undergo radiological tests of unclear clinical relevance.
The USA is amid an opioid-prescribing epidemic and resultant overdose public health emergency. A variety of reasons, which are examined in this manuscript, have contributed to the dramatic increase in the use of chronic opioid therapy for chronic non-cancer pain. This increase of opioid prescriptions and related deaths is based on many factors including the perception that there was systemic undertreatment of pain, the philosophical approach of advocacy groups for pain relief, promotion by the pharmaceutical industry, Joint Commission's Fifth Vital Sign, and permissive regulations by boards of medical licensures promoting excessive use of opioids. Overall, opioid treatment has been based on subjective pain relief and radiographic findings, which may not correlate with the source of pain generation. Radiologists, along with interventionalists, frequently interact with patients on chronic opioid therapy and at times take responsibility for patients with chronic pain. Beyond reading studies, diagnostic radiologists provide care to larger percentages of patients taking narcotics than ever before. This manuscript focuses on chronic pain, escalating opioid therapy, and adverse consequences, including the epidemic of overdoses and deaths. Radiologists' expertise can potentially reduce unnecessary radiological tests and inappropriate prescribing of medications.
慢性疼痛和处方类阿片类药物滥用的流行给患者和临床医生带来了严重的问题。其后果给患者、医生和社会造成了沉重的负担。具体到放射科，患者经常接受与临床相关性不明确的放射学检查，因此需要对疼痛管理的最佳实践评估和治疗方法进行评估。
美国正处于阿片类药物处方泛滥和由此导致的过量用药公共卫生紧急状态之中。本文探讨了多种导致慢性非癌性疼痛慢性阿片类药物治疗使用率显著增加的原因。阿片类药物处方的增加和相关死亡人数的增加基于许多因素，包括对疼痛治疗不足的系统性认识、倡导疼痛缓解的哲学方法、制药行业的推动、联合委员会的第五生命体征以及医疗执照委员会对阿片类药物过度使用的宽松监管。总的来说，阿片类药物治疗主要基于主观缓解疼痛和影像学发现，而这些可能与疼痛产生的根源无关。放射科医生与介入放射科医生一起，经常与接受慢性阿片类药物治疗的患者互动，有时还负责治疗慢性疼痛患者。除了阅读研究报告外，诊断放射科医生为比以往任何时候都更多的服用麻醉性镇痛药的患者提供护理。本文主要关注慢性疼痛、阿片类药物治疗的不断升级以及包括过量用药和死亡在内的不良后果。放射科医生的专业知识可以减少不必要的放射学检查和药物的不当处方。
