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日本疼痛临床医生学会《慢性非癌性疼痛阿片类镇痛药处方指南》(第三版)执行摘要

Executive summary of the guideline for prescribing opioid analgesics for chronic non-cancer pain (third edition) by the Japan Society of Pain Clinicians.

作者信息

Kanai Akifumi, Iseki Masako, Iida Hiroki, Yamaguchi Shigeki, Oiwa Ayano, Yonekura Hiroshi, Iwashita Narihito, Ueno Hiroshi, Kimura Yoshiyuki, Takasusuki Toshifumi, Yamaguchi Keisuke, Iida Shie, Ikemiya Hiroko, Oya Rina, Sugiyama Yoko, Tanabe Kumiko, Taniguchi Ayano, Hattammaru Yoshiyasu, Mizogami Maki, Yamaguchi Shinobu, Yamada Keiko, Fukui Sei

机构信息

Division of Dolorology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara City, Kanagawa Prefecture, 252-0374, Japan.

Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, Tokyo, Japan.

出版信息

J Anesth. 2025 Aug 11. doi: 10.1007/s00540-025-03559-x.


DOI:10.1007/s00540-025-03559-x
PMID:40789831
Abstract

Opioid analgesics are powerful pain relievers, but inappropriate use can cause a variety of problems. Especially, in chronic non-cancer pain, inappropriate use of opioid analgesics might fail to improve or even worsen the quality of life and activities of daily living of patients impaired by pain. The Japan Society of Pain Clinicians has developed the Guidelines for Prescribing Opioid Analgesics for Chronic Non-cancer Pain (Third Edition), which answers basic clinical questions concerning opioid management as summary statements in accordance with the most recent scientific evidence and expert opinion. The guidelines emphasize patient selection (e.g., obvious organic cause of the persistent pain, low risk of psychosocial factors, pain refractory to non-opioid therapies, and good adherence to medication). Furthermore, patients should be treated with an oral dose of 90 morphine milligram equivalents/day as the upper limit and target duration of 3-6 months. For pain in cancer survivors that is not directly caused by cancer, such as pain after treatment or pain associated with complications or pre-existing conditions, these guidelines should be followed.

摘要

阿片类镇痛药是强效的疼痛缓解药物,但不当使用会引发各种问题。尤其是在慢性非癌性疼痛中,不当使用阿片类镇痛药可能无法改善甚至会恶化因疼痛而受损的患者的生活质量和日常生活活动能力。日本疼痛临床医生协会制定了《慢性非癌性疼痛阿片类镇痛药处方指南(第三版)》,该指南依据最新科学证据和专家意见,以总结陈述的形式回答了有关阿片类药物管理的基本临床问题。该指南强调患者选择(例如,持续性疼痛有明显的器质性病因、社会心理因素风险低、对非阿片类疗法难治的疼痛以及对药物治疗的良好依从性)。此外,患者应以每日90毫克吗啡当量的口服剂量作为上限进行治疗,目标疗程为3至6个月。对于癌症幸存者中并非由癌症直接引起的疼痛,如治疗后疼痛或与并发症或既往疾病相关的疼痛,应遵循这些指南。

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本文引用的文献

[1]
The Impact of Gabapentinoids on Pain-Related Outcomes after Knee and Hip Surgery: A Systematic Review with Meta-Analysis of Randomized Controlled Trials.

J Clin Med. 2024-7-18

[2]
Multimodal Analgesia Bundle and Postoperative Opioid Use Among Patients Undergoing Colorectal Surgery.

JAMA Netw Open. 2023-9-5

[3]
Adverse outcomes associated with concurrent gabapentin, opioid, and benzodiazepine utilization: A nested case-control study.

Lancet Reg Health Am. 2022-6-23

[4]
Identifying High-Risk Comorbidities Associated with Opioid Use Patterns Using Electronic Health Record Prescription Data.

Complex Psychiatry. 2022-9

[5]
Will the New CDC Opioid Prescribing Guidelines Help Correct the Course in Pain Care?

JAMA. 2023-1-10

[6]
CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022.

MMWR Recomm Rep. 2022-11-4

[7]
Growing Role of Gabapentin in Opioid-Related Overdoses Highlights Misuse Potential and Off-label Prescribing Practices.

JAMA. 2022-10-4

[8]
Central sensitization in opioid use disorder: a novel application of the American College of Rheumatology Fibromyalgia Survey Criteria.

Pain Rep. 2022-7-7

[9]
Opioid-induced Hyperalgesia in Patients With Chronic Pain: A Systematic Review of Published Cases.

Clin J Pain. 2021-10-26

[10]
Persistent postoperative opioid use after total hip or knee arthroplasty: A systematic review and meta-analysis.

Am J Health Syst Pharm. 2022-1-24

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