Kurita Geana P, Sjøgren Per
Multidisciplinary Pain Center, Department of Anesthesia, Pain and Respiratory Support, Neuroscience Center, Rigshospitalet – Copenhagen University Hospital, Copenhagen, Denmark; Palliative Research Group, Department of Oncology, Center for Cancer and Organ Diseases, Rigshospitalet – Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Palliative Research Group, Department of Oncology, Center for Cancer and Organ Diseases, Rigshospitalet – Copenhagen University Hospital, Copenhagen, Denmark
Pol Arch Intern Med. 2021 Nov 30;131(11). doi: 10.20452/pamw.16136. Epub 2021 Nov 15.
Opioid therapy is indisputably the mainstay of cancer pain management. However, important issues such as the worldwide variability in the availability and accessibility of opioids, myths and misconceptions about opioid use, and lack of knowledge about prescribing opioids among health care professionals have been pointed out by researchers, clinicians, and several health organizations. In an attempt to improve cancer pain management, guidelines for opioid use were elaborated to assist practitioners in prescribing opioids for the management of cancer-related pain. Recent opioid guidelines were developed based on a systematic assessment of evidence and they are considered one of the best resources to improve knowledge and clinical practice. However, most of the recommendations for cancer pain management included in these guidelines are based on low levels of evidence, which demonstrates that more studies on the use of opioids in pain management are necessary. Moreover, the increased frequency of prescribing opioids for chronic noncancer pain has raised other issues, such as iatrogenic adverse effects, which may also occur in patients with cancer pain on long-term opioid therapy (L-TOT). In this narrative review, we discussed the role of opioid guidelines and recent knowledge regarding the consequences of L-TOT, in particular opioid addiction and deficiencies of the immune and endocrine systems. Finally, we addressed new strategies to strengthen the L-TOT in the management of cancer-related pain among patients in palliative care.
阿片类药物疗法无疑是癌症疼痛管理的主要手段。然而，研究人员、临床医生和一些卫生组织指出了一些重要问题，如全球范围内阿片类药物可及性和可获得性的差异、关于阿片类药物使用的误解和错误观念，以及医护人员在开具阿片类药物处方方面的知识欠缺。为了改善癌症疼痛管理，制定了阿片类药物使用指南，以帮助从业者开具阿片类药物来管理癌症相关疼痛。最近的阿片类药物指南是基于对证据的系统评估制定的，它们被认为是提高知识水平和临床实践的最佳资源之一。然而，这些指南中包含的大多数癌症疼痛管理建议都基于低水平的证据，这表明有必要对阿片类药物在疼痛管理中的使用进行更多研究。此外，为慢性非癌性疼痛开具阿片类药物的频率增加引发了其他问题，如医源性不良反应，长期阿片类药物治疗（L-TOT）的癌症疼痛患者也可能出现这种情况。在这篇叙述性综述中，我们讨论了阿片类药物指南的作用以及关于长期阿片类药物治疗后果的最新知识，特别是阿片类药物成瘾以及免疫和内分泌系统的缺陷。最后，我们探讨了在姑息治疗中加强长期阿片类药物治疗以管理癌症相关疼痛患者的新策略。
