慢性疼痛に対するオピオイドの処方に関するCDCガイドライン - 米国,2016年
Deborah Dowell1, Tamara M Haegerich1, Roger Chou1
1Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA
|March 16, 2016
まとめ
非オピオイド治療は慢性疼痛の治療に最適です. 慢性的な痛みに対するオピオイドの使用は,長期の有効性を制限し,オピオイド使用障害や過剰摂取を含む重大なリスクを伴います.
科学分野:
- 痛みの管理
- 薬理学について
- 公衆衛生
背景:
- 慢性疼痛の管理は 主要な医療従事者にとって 課題です
- 慢性疼痛に対するオピオイド療法の長期的な有効性は十分に確立されていません.
- オピオイドの使用は,オピオイド使用障害や過剰摂取を含む重大なリスクを伴う.
研究 の 目的:
- 慢性疼痛の成人を治療する医療従事者のためのオピオイド処方に関する最新の勧告を提供すること.
- ガイドラインは,がん,緩和ケア,または終末期状態の患者を除外しています.
主な方法:
- オピオイドの有効性とリスクに関する2014年の体系的なレビューを更新しました.
- 利益,害,価値,好み,コストに関する補足調査を実施した.
- 証拠の評価のために,勧告評価,開発,評価の格付け (GRADE) フレームワークを使用した.
主要な成果:
- 研究の限界と異質性のために,証拠の質は低い.
- 慢性疼痛に対する長期 (≥1年) のオピオイド効果を評価した研究はありませんでした.
- オピオイドは用量依存性の高いオピオイド使用障害,過剰摂取,死亡のリスクと関連していました.
結論:
- 非オピオイド治療は慢性疼痛の優先治療である.
- オピオイドは慎重に使用し,目標と中止計画を確立する必要があります.
- 重要な推奨事項は,最小有効用量,定期的な再評価,同時使用のオピオイドとベンゾジアゼピンの使用を避けることです.
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