急性疼痛与阿片类药物使用障碍的发展:患者风险因素。
Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors.
机构信息
Department of Anaesthesiology and Pain Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Faculty of Medicine, University of Bern, Bern, Switzerland.
出版信息
Curr Pain Headache Rep. 2023 Sep;27(9):437-444. doi: 10.1007/s11916-023-01127-0. Epub 2023 Jul 1.
PURPOSE OF REVIEW
Pharmacological therapy for acute pain carries the risk of opioid misuse, with opioid use disorder (OUD) reaching epidemic proportions worldwide in recent years. This narrative review covers the latest research on patient risk factors for opioid misuse in the treatment of acute pain. In particular, we emphasize newer findings and evidence-based strategies to reduce the prevalence of OUD.
RECENT FINDINGS
This narrative review captures a subset of recent advances in the field targeting the literature on patients' risk factors for OUD in the treatment for acute pain. Besides well-recognized risk factors such as younger age, male sex, lower socioeconomic status, White race, psychiatric comorbidities, and prior substance use, additional challenges such as COVID-19 further aggravated the opioid crisis due to associated stress, unemployment, loneliness, or depression. To reduce OUD, providers should evaluate both the individual patient's risk factors and preferences for adequate timing and dosing of opioid prescriptions. Short-term prescription should be considered and patients at-risk closely monitored. The integration of non-opioid analgesics and regional anesthesia to create multimodal, personalized analgesic plans is important. In the management of acute pain, routine prescription of long-acting opioids should be avoided, with implementation of a close monitoring and cessation plan.
目的综述
急性疼痛的药物治疗存在阿片类药物滥用风险,近年来阿片类药物使用障碍(OUD)在全球范围内达到流行程度。本综述涵盖了关于急性疼痛治疗中阿片类药物滥用患者风险因素的最新研究。特别是,我们强调了减少 OUD 患病率的最新发现和循证策略。
最近的发现
本综述涵盖了该领域的最新进展,重点关注急性疼痛治疗中 OUD 患者风险因素的文献。除了年龄较小、男性、社会经济地位较低、白种人、精神共病和既往物质使用等公认的风险因素外,COVID-19 等其他挑战由于相关压力、失业、孤独或抑郁,进一步加剧了阿片类药物危机。为了减少 OUD,提供者应评估个体患者的风险因素以及对阿片类药物处方的适当时机和剂量的偏好。应考虑短期处方,并密切监测高危患者。将非阿片类镇痛药和区域麻醉相结合以制定多模式、个性化镇痛方案很重要。在急性疼痛的管理中,应避免常规开具长效阿片类药物,并实施密切监测和停药计划。
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