Faculty of Medicine, Vilnius University, Republican Vilnius University Hospital, Toxicology Centre, Vilnius, Lithuania. ORCID: https://orcid.org/0000-0002-2417-8095.
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
J Opioid Manag. 2022 Jul-Aug;18(4):377-383. doi: 10.5055/jom.2022.0731.
Managing patients with chronic pain with long-term opioid therapy can be challenging for the prescribers, as the development of treatment complications such as addiction and opioid-induced hyperalgesia has to be considered. There is a paucity of information on the use of opioid detoxification protocols in patients with chronic pain on a long-term opioid therapy who have developed opioid-induced complications.
To determine the effectiveness of detoxification treatment while presenting a different opioid detoxification protocol intended to cease patient's prescription opioid use while assessing patient's quality of life (QoL) changes, implicated by our treatment.
We retrospectively studied 41 patients with chronic pain with long-term prescription opioid usage who underwent elective opioid detoxification in years 2010-2019 at the Toxicology Centre of Republican Vilnius University Hospital. We ceased prescription opioids during detoxification treatment and monitored withdrawal symptoms, pain intensity, and QoL by using SF-36 scores before and right after and a minimum of 3 months after detoxification.
This study was fully completed by 14 patients. At the third SF-36 evaluation, 12 out of 14 patients (85.71 percent) reported the detoxification treatment as beneficial to their overall health status compared to that before the treatment, and SF-36 scores after detoxification were significantly higher than before the treatment (p = 0.001). A decreased pain level right after detoxification was indicated by 11 patients (78.6 percent). Significant pain decrease was observed both right after and at least 3 months after the opioid detoxification treatment (p < 0.05).
As significant pain reduction, QoL life improvement, and opioid usage cessation were observed after opioid detoxification in the majority of patients with chronic pain, this leads us to believe that such a treatment can be safely administered and appropriated.
对于开具处方的医生来说，管理长期接受阿片类药物治疗的慢性疼痛患者可能具有挑战性，因为需要考虑治疗并发症的发展，如成瘾和阿片类药物诱发的痛觉过敏。关于长期接受阿片类药物治疗且出现阿片类药物诱发并发症的慢性疼痛患者使用阿片类药物解毒方案的信息很少。
确定解毒治疗的有效性，同时提出一种不同的阿片类药物解毒方案，旨在停止患者处方阿片类药物的使用，同时评估我们治疗引起的患者生活质量（QoL）变化。
我们回顾性研究了 2010 年至 2019 年在立陶宛共和国维尔纽斯大学医院毒理学中心接受选择性阿片类药物解毒的 41 例长期使用处方阿片类药物治疗的慢性疼痛患者。我们在解毒治疗期间停止处方阿片类药物，并在解毒前后和至少 3 个月后使用 SF-36 评分监测戒断症状、疼痛强度和 QoL。
本研究完全完成了 14 例患者。在第三次 SF-36 评估中，14 例患者中有 12 例（85.71%）报告解毒治疗对他们的整体健康状况有益，与治疗前相比，SF-36 评分在治疗后显著升高（p=0.001）。11 例患者（78.6%）表示在解毒后疼痛水平降低。在阿片类药物解毒治疗后，疼痛明显减轻，无论是在治疗后还是至少 3 个月后（p<0.05）。
大多数慢性疼痛患者在接受阿片类药物解毒后，疼痛明显减轻，生活质量提高，阿片类药物使用停止，这使我们相信这种治疗是安全和适当的。
