Schofferman J
San Francisco Spine-Institute, Daly City, California.
J Pain Symptom Manage. 1993 Jul;8(5):279-88. doi: 10.1016/0885-3924(93)90156-p.
The use of long-term opioids (LTOs) to treat chronic pain of nonmalignant origin (CNMP) is controversial. Most physicians had felt there was essentially no role for LTOs in CNMP, but successful treatment outcomes have recently been reported. Tolerance, organ toxicity, or fear of addiction are not reasons to limit LTOs. The significant question is efficacy. Does LTO therapy improve pain and increase function with minimal side effects or risk? It is useful to divide chronic pain patients into three types. Type 1 patients are "typical" chronic pain patients with pain and disability far out of proportion to the peripheral stimulus. Psychological factors are significant. In this type of patient, opioids appear to do more harm than good. Type 2 patients have ongoing nociception and moderate refractory pain. Type 3 patients have refractory severe nociception or neuropathic pain. The latter types might be considered for LTOs. LTO use is appropriate for a very small, carefully selected group of patients.
使用长效阿片类药物（LTOs）治疗非恶性起源的慢性疼痛（CNMP）存在争议。大多数医生曾认为LTOs在CNMP治疗中基本没有作用，但最近有成功治疗结果的报道。耐受性、器官毒性或对成瘾的恐惧都不是限制LTOs使用的理由。关键问题是疗效。LTO治疗能否以最小的副作用或风险改善疼痛并提高功能？将慢性疼痛患者分为三种类型会很有帮助。1型患者是“典型”的慢性疼痛患者，其疼痛和残疾程度与外周刺激严重不成比例。心理因素很重要。在这类患者中，阿片类药物似乎弊大于利。2型患者存在持续的伤害性感受和中度难治性疼痛。3型患者有难治性严重伤害性感受或神经性疼痛。后两种类型的患者可能适合使用LTOs。LTOs仅适用于经过精心挑选的极少数患者。
