Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
Department of Pharmacology, Louisiana State University Health Sciences Center at Shreveport, Toxicology, and Neurosciences, Shreveport, LA, 71103, USA.
Curr Pain Headache Rep. 2024 Jul;28(7):587-594. doi: 10.1007/s11916-024-01248-0. Epub 2024 Apr 2.
The abundance of opioids administered in the palliative care setting that was once considered a standard of care is at present necessitating that providers evaluate patients for unintentional and deleterious symptomology related to aberrant opioid use and addiction. Polypharmacy with opioids is dynamic in affecting patients neurologically, and increased amounts of prescriptions have had inimical effects, not only for the individual, but also for their families and healthcare providers. The purpose of this review is to widen the perspective of opioid consequences and bring awareness to the numerous neuropsychiatric effects associated with the most commonly prescribed opioids for patients receiving palliative care.
Numerous clinical and research studies have found evidence in support for increased incidence of opioid usage and abuse as well as undesirable neurological outcomes. The most common and concerning effects of opioid usage in this setting are delirium and problematic drug-related behavioral changes such as deceitful behavior towards family and physicians, anger outbursts, overtaking of medications, and early prescription refill requests. Other neuropsychiatric effects detailed by recent studies include drug-seeking behavior, tolerance, dependence, addictive disorder, anxiety, substance use disorder, emotional distress, continuation of opioids to avoid opioid withdrawal syndrome, depression, and suicidal ideation. Opioid usage has detrimental and confounding effects that have been overlooked for many years by palliative care providers and patients receiving palliative care. It is necessary, even lifesaving, to be cognizant of potential neuropsychiatric effects that opioids can have on an individual, especially for those under palliative care. By having an increased understanding and awareness of potential opioid neuropsychiatric effects, patient quality of life can be improved, healthcare system costs can be decreased, and patient outcomes can be met and exceeded.
在姑息治疗环境中给予阿片类药物的丰富程度曾被认为是一种标准的治疗方法，但目前需要提供者评估患者是否存在与异常阿片类药物使用和成瘾相关的非故意和有害症状。阿片类药物的多药治疗对患者的神经系统有影响，且增加的处方数量产生了有害的影响，不仅对个人，而且对他们的家庭和医疗保健提供者也是如此。本综述的目的是拓宽对阿片类药物后果的认识，并使人们意识到与接受姑息治疗的患者最常开的阿片类药物相关的许多神经精神影响。
许多临床和研究研究都发现了证据，证明阿片类药物的使用和滥用以及不良的神经学结果的发生率增加。在这种情况下，阿片类药物使用最常见和最令人担忧的影响是谵妄和与药物相关的行为问题，例如对家人和医生的欺骗行为、愤怒发作、药物过量以及提前要求处方续期。最近的研究详细描述了其他神经精神影响，包括觅药行为、耐受性、依赖性、成瘾障碍、焦虑、物质使用障碍、情绪困扰、继续使用阿片类药物以避免阿片类药物戒断综合征、抑郁和自杀意念。阿片类药物的使用产生了有害和混淆的影响，这些影响多年来一直被姑息治疗提供者和接受姑息治疗的患者忽视。即使对于接受姑息治疗的患者来说，意识到阿片类药物可能对个人产生的潜在神经精神影响也是必要的，甚至是救命的。通过增加对潜在阿片类药物神经精神影响的理解和认识，可以提高患者的生活质量，降低医疗保健系统的成本，并满足和超过患者的治疗效果。
