Paolo Procacci Foundation (PPF), Via Tacito 7, 00193, Rome, Italy.
World Institute of Pain, Winston-Salem, USA.
Drugs. 2020 Sep;80(14):1443-1453. doi: 10.1007/s40265-020-01369-x.
Pain management in both outpatient and inpatient settings demands a multidisciplinary approach entailing medical, physical and psychological therapies. Among these, multimodal analgesic regimens stand out as a promising treatment options. Cyclo-oxygenase (COX) inhibitor/opioid receptor agonist combinations hold great potential as effective pillars in the multimodal pain management by providing adequate analgesia with fewer safety risks due to COX inhibitors' opioid-sparing effect. Thus, these combinations, either freely or in fixed-dose formulation, offer a feasible option for the prescribing clinicians who seek to maximise therapeutic effect while simultaneously minimise adverse effects. The selection of the appropriate non-steroidal anti-inflammatory drug (NSAID) and opioid agent at optimal doses is essential. It should be tailored to the patients' analgesic necessities, and his/her gastrointestinal and cardiovascular risk, and potential concurrent aspirin use. Moreover, it should allow for addiction risk and the potential opioid-induced bowel dysfunction and constipation. To ensure an optimal match between the characteristics of the patient and the properties of the chosen medication, and to guide adequate and well-tolerated treatment decisions, it is of paramount importance to expand clinicians' knowledge of the currently available COX inhibitor/opioid receptor agonist combinations. This invited narrative review deals with the literature evidence covering the components of multimodal opioid-sparing analgesic regimens. Also, it provides insights into the clinically relevant choice criteria to ensure a patient-tailored analgesia.
在门诊和住院环境中进行疼痛管理需要采取多学科方法，包括医学、物理和心理治疗。在这些方法中，多模式镇痛方案作为一种有前途的治疗选择脱颖而出。环氧化酶 (COX) 抑制剂/阿片受体激动剂联合具有很大的潜力，因为 COX 抑制剂的阿片类药物节约作用可提供足够的镇痛效果，同时降低安全性风险，因此成为多模式疼痛管理的有效支柱。因此，这些联合用药（无论是自由联合还是固定剂量配方）为寻求最大限度提高治疗效果同时最大限度减少不良反应的处方临床医生提供了可行的选择。选择适当的非甾体抗炎药 (NSAID) 和阿片类药物，并以最佳剂量使用非常重要。它应根据患者的镇痛需求、胃肠道和心血管风险以及潜在的同时使用阿司匹林情况进行调整。此外，还应考虑成瘾风险以及潜在的阿片类药物引起的肠道功能障碍和便秘。为了确保患者特征与所选药物特性之间的最佳匹配，并指导适当且耐受良好的治疗决策，扩大临床医生对当前可用的 COX 抑制剂/阿片受体激动剂联合用药的了解至关重要。本邀请叙述性综述涉及涵盖多模式阿片类药物节约镇痛方案的组成部分的文献证据。此外，它还提供了有关临床相关选择标准的见解，以确保个体化镇痛。
