Eriksen J, Clausen T G, Borgbjerg F M
Multidisciplinaert smertecenter, afdeling R., Bispebjerg Hospital, København.
Ugeskr Laeger. 1994 Jan 31;156(5):621-3, 626-7.
Opioid sensitivity, residual pain, development of tolerance, physical and psychological dependence are described and discussed in relation to long-term opioid therapy. Based on this, guidelines for long-term opioid administration are established for chronic pain conditions of non-cancer origin. The indication must be well-considered--a life-long treatment may be instituted. Prior to final initiation of the treatment, a testing of the selected drug and method of administration should be performed. Due to the compliance-reasons, only long acting opioids should be used (controlled release morphine preparations, methadone, buprenorphine) and the route of administration should always be oral. The treatment must be individualised, covering 24 hours a day. The single dosages should be identical and administered with identical time intervals, which are determined by the duration of action of the drug in use. P.r.n.-administration should not be allowed. Only one physician should be responsible for the treatment and for the prescription of the opioid analgesic drugs.
本文描述并讨论了与长期阿片类药物治疗相关的阿片类药物敏感性、残余疼痛、耐受性发展、身体和心理依赖。基于此，针对非癌症起源的慢性疼痛状况制定了长期阿片类药物给药指南。必须充分考虑适应症——可能需要进行终身治疗。在最终开始治疗之前，应对所选药物和给药方法进行测试。出于依从性考虑，应仅使用长效阿片类药物（控释吗啡制剂、美沙酮、丁丙诺啡），且给药途径应始终为口服。治疗必须个体化，覆盖一天24小时。单次剂量应相同，并以相同的时间间隔给药，该时间间隔由所用药物的作用持续时间决定。不应允许按需给药。应由一名医生负责治疗和阿片类镇痛药物的处方。
