Division of Pain Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Semin Nephrol. 2021 Jan;41(1):68-81. doi: 10.1016/j.semnephrol.2021.02.007.
Opioid analgesics carry risk for serious health-related harms in patients with advanced chronic kidney disease (CKD) and end-stage kidney disease. In the general population with chronic noncancer pain, there is some evidence that opioid reduction or discontinuation is associated with improved pain outcomes; however, tapering opioids abruptly or without providing supportive interventions can lead to physical and psychological harms and relapse of opioid use. There is emerging evidence that nonpharmacologic treatments such as psychosocial interventions, acupuncture, and interdisciplinary pain management programs are effective approaches to support opioid dose reduction in patients experiencing persistent pain, but research in this area still is relatively new. This review describes the current evidence for nonpharmacologic interventions to support opioid reduction in non-CKD patients with pain and discusses the application of the available evidence to patients with advanced CKD who are prescribed opioids to manage pain.
阿片类镇痛药在晚期慢性肾脏病（CKD）和终末期肾病患者中存在严重与健康相关损害的风险。在患有慢性非癌痛的普通人群中，有一些证据表明减少或停止使用阿片类药物与改善疼痛结局有关；然而，突然减少或不提供支持性干预措施的阿片类药物可能会导致身体和心理伤害以及阿片类药物使用的复发。越来越多的证据表明，非药物治疗方法，如心理社会干预、针灸和跨学科疼痛管理计划，是支持持续疼痛患者减少阿片类药物剂量的有效方法，但这方面的研究仍然相对较新。这篇综述描述了支持非 CKD 疼痛患者减少阿片类药物的非药物干预措施的现有证据，并讨论了将现有证据应用于接受阿片类药物治疗疼痛的晚期 CKD 患者的情况。
