Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Unit 1414, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
Curr Treat Options Oncol. 2019 Apr 1;20(5):39. doi: 10.1007/s11864-019-0636-3.
Although clinical evidence supports the use of opioids for cancer-related pain, doing so amidst the current opioid crisis remains a challenge. A proportion of opioid-related deaths in the USA are attributable to prescription opioids, which implicates health care providers as one of the major contributors. It is therefore even more important now for all clinicians to follow safe and effective opioid prescribing practices. Oncologists are often in the frontline of cancer pain management. They are encouraged to use validated tools to screen all patients receiving opioids for high risk behaviors. Those identified as high risk for potential abuse of opioids should be monitored closely. When aberrant behavior is detected, the clinician will need to openly discuss the issue and its possible implications. Oncologists may then implement measures such as limiting the dose and quantity of opioids prescribed, shortening interval between follow-ups for refills to allow for increased monitoring, setting boundaries/limitations, weaning off opioid analgesics, or/and referring to a pain or palliative medicine or drug addiction expert for co-management when necessary. These efforts may aid oncologists in safely managing cancer pain in the environment of national opioid crisis.
尽管临床证据支持将阿片类药物用于癌症相关疼痛，但在当前阿片类药物危机中这样做仍然是一个挑战。美国部分阿片类药物相关死亡归因于处方阿片类药物，这表明医疗保健提供者是主要贡献者之一。因此，现在所有临床医生都更应该遵循安全有效的阿片类药物处方实践。肿瘤学家通常处于癌症疼痛管理的第一线。他们被鼓励使用经过验证的工具对所有接受阿片类药物治疗的患者进行高危行为筛查。那些被认为有滥用阿片类药物风险的患者应密切监测。当发现异常行为时，临床医生将需要公开讨论问题及其可能的影响。然后，肿瘤学家可以采取措施，如限制阿片类药物的剂量和数量、缩短随访时间以增加监测、设定界限/限制、逐渐减少阿片类镇痛药、或/和在必要时转介疼痛或姑息医学或药物滥用专家进行共同管理。这些努力可能有助于肿瘤学家在国家阿片类药物危机环境中安全管理癌症疼痛。
