University of Maryland School of Pharmacy, Baltimore, Maryland, USA
Oncologist. 2019 Dec;24(12):1505-1509. doi: 10.1634/theoncologist.2019-0340. Epub 2019 May 31.
Prescription opioids are commonly prescribed for the relief of many kinds of pain syndromes, including cancer pain. In order to combat the growing rates of abuse and misuse of prescription opioids, the Centers for Disease Control and Prevention, along with the U.S. Food and Drug Administration and multiple pharmaceutical companies, have implemented many risk mitigation strategies. Abuse-deterrent drug delivery technology and more consistent prescribing of the opioid antagonist, naloxone, are two of the mechanisms of reducing harm in patients on chronic opioid therapy. Abuse-deterrent technology is implemented into different commercially available opioid products with the intent of discouraging manipulation of the opioid or making the use of the manipulated opioid less appealing. Use of the opioid antagonist, naloxone, for reversal of intentional or unintentional opioid overdose is a safe and effective means to reduce potential risk in patients who are on opioids for pain management. These mechanisms have multiple advantages and limitations that influence their practical use specifically in patients with cancer pain. Patients with cancer pain have unique therapeutic needs and goals, and their balance of treatment risks and benefits differs from that of other kinds of chronic pain disorders. This article provides an overview of the advantages and limitations of these specific harm-reduction strategies and provides guidance on how to practically utilize them when caring for patients with cancer pain. IMPLICATIONS FOR PRACTICE: Treating cancer pain has important and unique considerations compared with other chronic, noncancer pain disorders. The use of risk mitigation strategies for opioid prescribing as promoted by the Centers for Disease Control and Prevention does not translate seamlessly to patients with cancer. It is crucial to be wary of the advantages and pitfalls of all risk mitigation strategies related to opioid use in patients with cancer pain. Careful examination of patient-specific risks and benefits should always be considered when implementing pharmacologic treatment and harm-reduction strategies for the management of cancer pain.
处方类阿片常用于缓解多种疼痛综合征，包括癌症疼痛。为了应对处方类阿片滥用和误用率不断上升的问题，疾病控制与预防中心与美国食品药品监督管理局以及多家制药公司合作，实施了许多降低风险的策略。滥用防御型药物传输技术和更一致地开具阿片类拮抗剂纳洛酮处方是减少慢性类阿片治疗患者伤害的两种机制。滥用防御型技术被应用于不同的市售类阿片产品，旨在阻止对类阿片的操纵或减少操纵类阿片的吸引力。使用阿片类拮抗剂纳洛酮逆转故意或意外的阿片类药物过量是一种安全有效的方法，可以降低正在接受阿片类药物治疗疼痛管理的患者的潜在风险。这些机制具有多种优点和局限性，影响其在癌症疼痛患者中的实际应用。癌症疼痛患者具有独特的治疗需求和目标，他们的治疗风险和获益平衡与其他类型的慢性疼痛障碍不同。本文概述了这些特定的减少伤害策略的优缺点，并就如何在护理癌症疼痛患者时实际利用这些策略提供了指导。
与其他慢性非癌症疼痛障碍相比，治疗癌症疼痛有重要而独特的考虑因素。疾病控制与预防中心推广的处方类阿片风险缓解策略并不完全适用于癌症患者。对于与癌症疼痛患者使用类阿片相关的所有风险缓解策略的优缺点，必须保持警惕。在实施药物治疗和减少伤害策略来管理癌症疼痛时，始终应仔细考虑患者特定的风险和获益。
