Gary M. Ruoff, MD, Clinical Professor of Family Medicine, Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, Michigan.
J Fam Pract. 2022 Jul;71(6 Suppl):S29-S33. doi: 10.12788/jfp.0418.
The use of opioids in acute pain may be appropriate in some situations, but there are opportunities to reduce exposure to opioids with equally effective monotherapy and combination therapy over-thecounter (OTC) medications. There are a number of OTC analgesics that are readily accessible and costeffective options to treat pain. The American College of Rheumatology Osteoarthritis Guideline "strongly" recommends the use of topical nonsteroidal antiinflammatory drugs (NSAIDs) and oral NSAIDs to treat arthritis pain, and it conditionally recommends against the use of opioids (other than tramadol). The American Headache Society suggests that OTC NSAIDs and combination medications such as acetaminophen, aspirin, and caffeine are Level A recommendations for reducing migraine pain and other symptoms. Nonopioid OTC analgesics, such as NSAIDs and the NSAID/acetaminophen combination, are safe and effective firstline options for managing acute dental pain according to the American Dental Association. The American College of Physicians supports the use of NSAIDs as first-line therapy for the treatment of low back pain.
在某些情况下,阿片类药物在急性疼痛中可能是合适的,但有机会通过同样有效的单药治疗和联合治疗非处方 (OTC) 药物来减少阿片类药物的暴露。有许多 OTC 镇痛药易于获得且具有成本效益,可以治疗疼痛。美国风湿病学会骨关节炎指南“强烈”建议使用局部非甾体抗炎药 (NSAIDs) 和口服 NSAIDs 治疗关节炎疼痛,并有条件地反对使用阿片类药物(除曲马多外)。美国头痛协会建议,对于减少偏头痛疼痛和其他症状,OTC NSAIDs 和复方药物(如对乙酰氨基酚、阿司匹林和咖啡因)是 A 级推荐。根据美国牙科协会的说法,非阿片类 OTC 镇痛药,如 NSAIDs 和 NSAID/对乙酰氨基酚联合制剂,是安全有效的一线治疗急性牙痛的选择。美国医师学院支持 NSAIDs 作为一线治疗腰痛的治疗方法。