Departments of Family Medicine and Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, Calgary, AB, Canada.
J Neurosci Res. 2022 Jan;100(1):10-18. doi: 10.1002/jnr.24695. Epub 2020 Aug 7.
Given the ubiquitous nature of opioids in the treatment of pain, it is an interesting paradox that this class of medications also represents one of the least understood components of clinical pain medicine. For many years, there has been intense interest in the mechanisms of opioid activity, but this has not resulted in a corresponding increase in convincing clinical data. This review focuses primarily on the evidence surrounding the long-term use of opioids in chronic pain, but discussions of this research are often conflated with the very different data governing acute and cancer-related pain, where evidence of efficacy is clearer. It is therefore important to clarify the evidence-based indications for opioid therapy. There remains very little evidence that opioids improve function or quality of life beyond 3 months in people with chronic pain conditions. In all three patient populations, the development of tolerance, dependence, hyperalgesia and withdrawal are key phenomena that affect the patient experience, and in particular the decision to remain on opioids in the long term. This is a common thread that connects the opioid literature in all of these spheres, and justifies the burgeoning interest in these phenomena in the basic science literature. There is an urgent need to address these negative consequences of opioid use, in order to maximize the therapeutic benefit that opioids can offer.
鉴于阿片类药物在疼痛治疗中的普遍存在，这是一个有趣的悖论，即这类药物也是临床疼痛医学中最不被理解的组成部分之一。多年来，人们对阿片类药物作用机制一直有着浓厚的兴趣，但这并没有带来相应的更有说服力的临床数据。本综述主要关注长期使用阿片类药物治疗慢性疼痛的证据，但对这方面研究的讨论往往与管理急性和癌症相关疼痛的非常不同的数据混淆在一起，因为后者的疗效证据更为明确。因此，明确阿片类药物治疗的循证指征非常重要。几乎没有证据表明阿片类药物能改善慢性疼痛患者 3 个月以上的功能或生活质量。在所有这三种患者群体中，耐受、依赖、痛觉过敏和戒断的发展是影响患者体验的关键现象，特别是长期使用阿片类药物的决定。这是贯穿所有这些领域阿片类文献的共同主线，也证明了基础科学文献中对这些现象日益增长的兴趣是合理的。迫切需要解决阿片类药物使用的这些负面影响，以最大限度地提高阿片类药物所能提供的治疗效益。
