Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France; Fondation Institut Analgesia, Faculté de Médecine, F-63001, Clermont-Ferrand, France.
Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, F-63003, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) / French Monitoring Centre for Analgesic Drugs, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63001, Clermont-Ferrand, France.
Neurosci Biobehav Rev. 2021 Feb;121:160-174. doi: 10.1016/j.neubiorev.2020.12.015. Epub 2020 Dec 28.
Chronic pain is a major public health issue that frequently leads to analgesic opioid prescriptions. These prescriptions could cause addiction issues in high-risk patients with associated comorbidities, especially those of a psychiatric, addictive, and social nature. Pain management in dependent patients is complex and is yet to be established. By combining the views of professionals from various specialties, we conducted an integrative review on this scope. This methodology synthesizes knowledge and results of significant practical studies to provide a narrative overview of the literature. The main results consisted in first proposing definitions that could allow shared vocabulary among health professionals regardless of their specialties. Next, a discussion was conducted around the main strategies for managing prescription opioid dependence, as well as pain in the context of opioid dependence and associated comorbidities. As a conclusion, we proposed to define the contours of holistic management by outlining the main guidelines for creating a multidisciplinary care framework for multi-comorbid patients with chronic pathologies.
慢性疼痛是一个主要的公共卫生问题,常导致阿片类镇痛药处方。这些处方可能会导致有相关合并症的高风险患者出现成瘾问题,尤其是那些精神、成瘾和社会性质的问题。依赖患者的疼痛管理较为复杂,尚未建立。通过结合来自不同专业的专业人员的观点,我们对这一领域进行了综合回顾。这种方法综合了重要实际研究的知识和结果,为文献提供了叙述性概述。主要结果首先提出了定义,这些定义可以使卫生专业人员之间无论其专业如何都能够使用共同的词汇。其次,围绕管理处方类阿片类药物依赖以及阿片类药物依赖和相关合并症背景下的疼痛的主要策略进行了讨论。作为结论,我们建议通过概述为患有慢性疾病的多合并症患者创建多学科护理框架的主要指南来定义整体管理的轮廓。