MJHS Institute for Innovation in Palliative Care, New York, New York.
Albert Einstein College of Medicine, The Bronx, New York.
J Am Geriatr Soc. 2020 Apr;68(4):691-698. doi: 10.1111/jgs.16340. Epub 2020 Mar 26.
The adjuvant analgesics are a large and diverse group of drugs that were developed for primary indications other than pain and are potentially useful analgesics for one or more painful conditions. The "adjuvant" designation reflects their early use as opioid co-analgesics for cancer pain. During the past 3 decades, their role in pain management has changed with the advent of many new entities, emerging data from numerous analgesic trials, and growing clinical experience. Many of these drugs are now used as primary analgesics for specific types of chronic pain. With proper patient selection and cautious administration, they can potentially contribute meaningfully to the management of chronic pain in older adults. A practical approach categorizes the many adjuvant analgesics by broad indications: multipurpose drugs and drugs that target neuropathic pain, musculoskeletal pain, and cancer pain, respectively. This article reviews the status of the evidence supporting the analgesic potential of the adjuvant analgesics and discusses best practices in terms of drug selection and dosing. J Am Geriatr Soc 68:691-698, 2020.
辅助镇痛药是一大类和多样化的药物，它们最初并非为治疗疼痛而开发，而是具有治疗一种或多种疼痛病症的潜力。“辅助”的指定反映了它们早期作为阿片类药物辅助治疗癌症疼痛的用途。在过去的 30 年中，随着许多新实体的出现、来自众多镇痛试验的新数据以及不断增加的临床经验，它们在疼痛管理中的作用发生了变化。许多这些药物现在被用作特定类型慢性疼痛的主要镇痛药。通过适当的患者选择和谨慎的管理，它们可能会对老年人慢性疼痛的管理产生有意义的影响。一种实用的方法是根据广泛的适应证对许多辅助镇痛药进行分类：多用途药物和分别针对神经病理性疼痛、肌肉骨骼疼痛和癌症疼痛的药物。本文回顾了支持辅助镇痛药镇痛潜力的证据状况，并讨论了药物选择和剂量方面的最佳实践。美国老年医学会杂志 68:691-698, 2020。
