Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Psychopharmacology Unit, Geneva University Hospitals, Geneva, Switzerland.
Division of Psychiatric Specialties, Department of Psychiatry and Mental Health, Unit for Intellectual Disabilities and Autism in Adults, Geneva University Hospitals, Geneva, Switzerland.
Eur J Pain. 2020 May;24(5):875-885. doi: 10.1002/ejp.1547. Epub 2020 Mar 9.
Having to deal on a daily routine with prescriptions in adults with intellectual disability (ID), we systematically reviewed the literature on the specificities of pain interventions in that population, focusing on medication and trying to gather practical information on appropriate pain treatments. Given the scarcity of the literature on the topic, we also discussed the pharmacological considerations to be taken into account when prescribing analgesic drugs in that vulnerable population.
Articles on pain and ID were searched in the Medline and Google scholar electronic databases using the key words "Intellectual Disability," "Developmental Disability" and specific keywords for pharmacological and non-pharmacological pain interventions. Preset outcomes about pharmacological treatment specificity, efficacy and safety were then collected.
One hundred and fifty-two articles were found and 16 were retained based on our inclusion and exclusion criteria. Of the 16 articles, five were topical reviews. Among the 11 remaining articles, five discussed pharmacological interventions, four considered non-pharmacological interventions and two discussed both. As anticipated, the literature matching our specific outcomes about the pharmacological treatment of pain was scarce and for the most part not designed to answer the questions of specificity, efficacy and safety of pain treatment in adults with ID.
The specificity of analgesic treatments in adults with ID is a totally unexplored domain. In the absence of clinical guidelines, pharmacological facts-such as inter-individual variability in drug response, pharmacokinetic and pharmacodynamic interactions, frequent co-morbidities and ease of administration-must be systematically integrated, when prescribing in the population of adults with ID.
This review synthesizes the state of research on pain interventions in adults with ID and is one of the rare articles addressing the specificities of analgesic prescriptions in this population.
在日常工作中，我们需要处理成年智障患者（ID）的处方，因此我们系统地回顾了该人群中疼痛干预的特殊性的文献，重点关注药物，并试图收集有关适当疼痛治疗的实用信息。鉴于该主题的文献稀缺，我们还讨论了在为该弱势群体开处方时应考虑的药理学注意事项。
使用关键词“智力障碍”、“发育障碍”和药理学及非药理学疼痛干预的特定关键词，在 Medline 和 Google scholar 电子数据库中搜索有关疼痛和 ID 的文章。然后收集有关药理学治疗特异性、疗效和安全性的预设结果。
共发现 152 篇文章，根据纳入和排除标准保留了 16 篇。在 16 篇文章中，有 5 篇是专题综述。在其余 11 篇文章中，有 5 篇讨论了药理学干预，4 篇考虑了非药理学干预，2 篇同时讨论了这两个方面。正如预期的那样，与我们关于 ID 成人疼痛的药理学治疗的具体结果匹配的文献很少，而且大多数不是为了回答 ID 成人疼痛治疗的特异性、疗效和安全性问题而设计的。
在 ID 成人中，镇痛治疗的特异性是一个完全未被探索的领域。在缺乏临床指南的情况下，必须系统地整合药理学事实，例如药物反应的个体间变异性、药代动力学和药效学相互作用、频繁的合并症和给药的便利性，当为 ID 成人人群开处方时。
本综述综合了关于 ID 成人疼痛干预的研究状况，是少数几篇专门讨论该人群镇痛处方特殊性的文章之一。
