Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Department of Pharmacy, University Health Network, Toronto, Ontario, Canada.
J Clin Pharm Ther. 2020 Dec;45(6):1295-1300. doi: 10.1111/jcpt.13208. Epub 2020 Jul 22.
Opioids are often used to treat chronic non-cancer pain (CNCP) in patients on haemodialysis. Altered pharmacokinetics in this population increases risk for opioid-related adverse events. Although useful in pain management, there is a lack of opioid prescribing guidance for end-stage kidney disease.
To characterize opioid usage for CNCP in an outpatient haemodialysis unit.
Cross-sectional, single-centre, retrospective cohort study of 272 patients receiving outpatient haemodialysis between 01 June and 31 December 2017. Prevalence of prescription or non-prescription opioids, formulation, indication, dosing, prescriber type and therapeutic effectiveness were evaluated.
A total of 27 (10%, aged 58 + 12.1 years, 59% women) patients received opioids for CNCP during the study period. Pain aetiology was diverse; 14 (52%) patients experienced multiple concurrent chronic pain conditions. Hydromorphone (55%) and oxycodone (37%) were the most common prescriptions. A majority (85%) of patients used non-opioid analgesics as adjunct therapy, while half (48%) used benzodiazepines or zopiclone concurrently. Patients who completed a pain scale (n = 10) reported a median pain intensity of 6.8/10 ([IQR], 4.5-7.3).
Opioid usage was lower than expected despite a higher prevalence of concurrent chronic pain conditions. Though this was within opioid usage guidelines, pain may not be sufficiently controlled. High concomitant use of benzodiazepines and Z-drugs introduces the potential for additive adverse effects. Judicious opioid usage can be facilitated with stewardship to effectively treat pain while avoiding associated harms and manage potential drug-drug interactions with common concomitant medications.
The prevalence of chronic opioid use for non-cancer pain in haemodialysis patients was lower than expected at our centre. Despite following the recommended guidelines, pain management was relatively ineffective, and concomitant use of non-opioid analgesics was widespread. Opioid stewardship is recommended to optimize pain treatment and mitigate drug interaction risks.
阿片类药物常用于治疗血液透析患者的慢性非癌性疼痛（CNCP）。该人群中药物代谢动力学的改变增加了与阿片类药物相关的不良反应的风险。尽管阿片类药物在疼痛管理中很有用，但终末期肾病的阿片类药物处方指南却很缺乏。
描述门诊血液透析单位中 CNCP 的阿片类药物使用情况。
对 2017 年 6 月 1 日至 12 月 31 日期间接受门诊血液透析的 272 例患者进行了横断面、单中心、回顾性队列研究。评估了处方或非处方阿片类药物的使用情况、剂型、适应证、剂量、开具处方的类型和治疗效果。
在研究期间，共有 27 例（10%，年龄 58+12.1 岁，59%为女性）患者因 CNCP 接受阿片类药物治疗。疼痛病因多种多样；14 例（52%）患者同时患有多种慢性疼痛疾病。氢吗啡酮（55%）和羟考酮（37%）是最常见的处方。大多数（85%）患者使用非阿片类镇痛药作为辅助治疗，而一半（48%）患者同时使用苯二氮䓬类或唑吡坦。完成疼痛量表（n=10）的患者报告的中位数疼痛强度为 6.8/10（IQR，4.5-7.3）。
尽管同时存在更多的慢性疼痛疾病，但阿片类药物的使用低于预期。尽管这符合阿片类药物使用指南，但疼痛可能未得到充分控制。苯二氮䓬类药物和 Z 类药物的高同时使用率增加了潜在的不良反应。通过管理来合理使用阿片类药物，可以有效地治疗疼痛，同时避免相关的危害，并管理与常见伴随药物的潜在药物-药物相互作用。
我们中心慢性阿片类药物治疗血液透析患者非癌性疼痛的患病率低于预期。尽管遵循了推荐的指南，但疼痛管理效果相对较差，非阿片类镇痛药的广泛使用。建议进行阿片类药物管理，以优化疼痛治疗并减轻药物相互作用的风险。
