[オピオイドを減量するか減量しないか - それが問題です]
Emmanuel Bäckryd1, Paulin Andréll2, Marcelo Rivano Fischer3
1bitr -professor, över-läkare, Linköpings -universitet.
まとめ
慢性非がん性疼痛に対する長期オピオイド治療は証拠が不足しており,欧州のガイドラインでは推奨されていません. 継続的な評価と早期の中止は,有害な結果を予防するために極めて重要です.
科学分野:
- 痛みの管理
- 薬理学について
- 公衆衛生
背景:
- 慢性非がん性疼痛に対する長期オピオイド治療の根拠は限られている.
- 主要な慢性疼痛の治療には オピオイドの使用は推奨されていません.
- オピオイドの利益と害の継続的な評価は不可欠です.
研究 の 目的:
- 慢性非がん性疼痛の長期オピオイド治療の複雑さを強調する
- オピオイドの減量 (処方停止) の重要性を強調する.
- オピオイドの摂取量減少に伴う潜在的な利益とリスクを概説する.
主な方法:
- オピオイドの長期使用に関する現在のガイドラインと臨床的検討のレビュー
- 計画された支援とフォローアップを含む,縮小プロセスの議論.
- 潜在的利益 (安全性,副作用の回復) とリスク (禁酒,精神的健康) の分析
主要な成果:
- オピオイドの減量療法は 利点とリスクを伴う 複雑な医療処置です
- 離脱症状や痛みの悪化や 精神的な健康問題などがあります
- 問題のあるオピオイド使用とオピオイド使用障害は,この患者集団における懸念事項です.
結論:
- オピオイドの減量には 慎重に計画し サポートし 監視する必要があります
- オピオイドを問題視する患者に対する態度を汚すのは避けるべきです.
- オピオイドの早期中止は,健康への悪影響を防ぐために検討されるべきです.
関連する概念動画
Opioid Analgesics: Synthetic and Semisynthetic Opioids
426
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
426
Opioid Analgesics: Morphine and Other Natural Cogeners
361
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
361
Analgesia and Pain Management
788
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
788
Desensitization and Tachyphylaxis
2.2K
Tachyphylaxis is described as a rapid decrease in response to a drug after repeated or continuous administration of the same drug dose. It is a phenomenon where the body becomes less responsive to a particular substance or intervention over time, requiring higher doses or stronger interventions to achieve the same effect. It results from adaptive changes in the body's receptors, signaling pathways, or physiological processes that occur in response to prolonged exposure to a stimulus.
2.2K
Opioid Receptors: Overview
1.8K
Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
1.8K
Drugs Affecting GI Tract Motility: Opioids as Antidiarrheal Agents
326
Diarrhea, a condition marked by frequent loose or watery bowel movements, can be triggered by multiple factors such as viral or bacterial infections, food intolerances, anxiety, medications, and digestive disorders. Symptoms may include abdominal pain, bloating, nausea, and cramping. Severe or prolonged diarrhea can lead to complications like electrolyte imbalances, malnutrition, and dehydration if left untreated.
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
326


