a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
Int Rev Psychiatry. 2018 Oct;30(5):136-146. doi: 10.1080/09540261.2018.1514369. Epub 2018 Nov 6.
Chronic pain (CP) and opioid use disorder (OUD) remain challenging complex public health concerns. This is an updated review on the relationship between CP and OUD and the use of stepped care models for assessment and management of this vulnerable population. A literature search was conducted from 2008 to the present in PubMed, Embase, and PsycInfo using the terms pain or chronic pain and opioid-related disorders, opiate, methadone, buprenorphine, naltrexone, opioid abuse, opioid misuse, opioid dependen*, heroin addict, heroin abuse, heroin misuse, heroin dependen*, or analgesic opioids, and stepped care, integrated services, multidisciplinary treatment, or reinforcement-based treatment. Evidenced-based data exists on the feasibility, implementation, and efficacy of stepped care models in primary care settings for the management of CP and opioid use. Although these studies did not enroll participants with OUD, they included a sub-set of patients at risk for the development of OUD. There remains a dearth of treatment options for those with comorbid CP and OUD. Future research is needed to explore the aetiology and impact of CP and OUD, and greater emphasis is needed to improve access to comprehensive pain and substance use programmes for high-risk individuals.
慢性疼痛（CP）和阿片类药物使用障碍（OUD）仍然是具有挑战性的复杂公共卫生问题。这是一篇关于 CP 和 OUD 之间关系的最新综述，以及使用分级护理模式来评估和管理这一脆弱人群的研究。使用“疼痛或慢性疼痛”和“阿片类相关障碍”、“鸦片”、“美沙酮”、“丁丙诺啡”、“纳曲酮”、“阿片类滥用”、“阿片类误用”、“阿片类依赖”、“海洛因成瘾者”、“海洛因滥用”、“海洛因误用”、“海洛因依赖”或“镇痛阿片类药物”等术语，在 PubMed、Embase 和 PsycInfo 中对 2008 年至目前的文献进行了检索。在初级保健环境中，针对 CP 和阿片类药物使用的管理，分级护理模式在可行性、实施和疗效方面存在循证数据。尽管这些研究没有招募 OUD 患者，但它们包括了一组有发生 OUD 风险的患者。对于同时患有 CP 和 OUD 的患者，治疗选择仍然有限。需要进一步的研究来探索 CP 和 OUD 的病因和影响，并需要更加重视为高风险个体提供全面的疼痛和物质使用计划。
