Paul J. Christo, M.D., M.B.A., is Associate Professor, Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine. He earned a B.S. from University of Notre Dame, Notre Dame, IN, an M.D. from University of Louisville School of Medicine, Louisville, KY, and an M.B.A. from The Johns Hopkins Carey School of Business, Baltimore, MD.
J Law Med Ethics. 2020 Jun;48(2):241-248. doi: 10.1177/1073110520935335.
Patients living with chronic pain require appropriate access to opioid therapy along with improved access to pain care and additional therapeutic options. It's both medically reasonable and ethical to consider opioid therapy as a treatment option in the management of chronic, non-cancer pain for a subset of patients with severe pain that is unresponsive to other therapies (e.g., injections, other medications, integrative strategies), negatively impacts function or quality of life, and will likely outweigh the potential harms. This paper will examine opioid therapy in the setting of the opioid epidemic, why critics feel that the CDC guideline has resulted in harsh consequences for patients and their physicians, and the rationale for opioid therapy as a means of providing ethical and compassionate pain care.
患有慢性疼痛的患者需要适当获得阿片类药物治疗,同时需要改善疼痛护理和增加其他治疗选择。对于某些严重疼痛且对其他治疗方法(如注射、其他药物、综合策略)无反应、对功能或生活质量产生负面影响且可能超过潜在危害的患者,将阿片类药物治疗作为慢性非癌性疼痛管理的一种治疗选择,既具有医学合理性,也符合伦理道德。本文将探讨在阿片类药物流行的背景下的阿片类药物治疗,为什么批评者认为疾病预防控制中心的指南对患者及其医生造成了严厉的后果,以及将阿片类药物治疗作为提供合乎伦理和富有同情心的疼痛治疗的一种手段的基本原理。