Hawley Chelsea E, Hickey Erin, Triantafylidis Laura K
New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA.
Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA.
Semin Nephrol. 2021 Jan;41(1):2-10. doi: 10.1016/j.semnephrol.2021.02.001.
Individuals with kidney disease have a high prevalence of chronic noncancer pain. Although opioids are not a recommended treatment option for chronic noncancer pain in the general population, a higher percentage of individuals with kidney disease receive opioid prescriptions for chronic pain. Individuals with kidney disease have an increased risk for opioid adverse events because of changes related to kidney disease progression, normative aging, and the pharmacology of opioid medications. Despite the frequent prescription of opioids for chronic noncancer pain among those with kidney disease, there are no guidelines for opioid management in this population. This article reviews the pharmacologic challenges of opioid use in relation to the physiologic changes occurring in kidney disease and normative aging. We highlight how understanding opioid pharmacology and human physiology can support safe practices of opioid management in patients with kidney disease who require opioids for chronic noncancer pain.
肾病患者慢性非癌性疼痛的患病率很高。尽管阿片类药物并非一般人群慢性非癌性疼痛的推荐治疗选择，但较高比例的肾病患者因慢性疼痛而接受阿片类药物处方。由于与肾病进展、正常衰老以及阿片类药物药理学相关的变化，肾病患者发生阿片类药物不良事件的风险增加。尽管肾病患者中慢性非癌性疼痛经常使用阿片类药物处方，但该人群尚无阿片类药物管理指南。本文综述了与肾病和正常衰老过程中发生的生理变化相关的阿片类药物使用的药理学挑战。我们强调了解阿片类药物药理学和人体生理学如何支持对因慢性非癌性疼痛需要使用阿片类药物的肾病患者进行安全的阿片类药物管理。
