美国疾病预防控制中心为慢性疼痛处方阿片类药物的指导方针,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
概括
非阿片类药物治疗最好用于慢性疼痛治疗. 使用阿片类药物治疗慢性疼痛的长期疗效有限,包括阿片类药物使用障碍和过量服用的重大风险.
科学领域:
- 治疗疼痛
- 药理学
- 公共卫生
背景情况:
- 治疗慢性疼痛对初级保健医生来说是一个挑战.
- 长期阿片类药物治疗慢性疼痛的有效性尚未得到充分证实.
- 吸食阿片类药物带来重大风险,包括阿片类药物使用障碍和过量服用.
研究的目的:
- 为治疗慢性疼痛的成年患者的初级保健医生提供更新的阿片类药物处方建议.
- 指南不包括患有活跃癌症,息治疗或生命末期疾病的患者.
主要方法:
- 更新了2014年关于阿片类药物的有效性和风险的系统审查.
- 对益处,危害,价值,偏好和成本进行了补充审查.
- 使用推评估,开发和评估 (GRADE) 框架进行证据评估.
主要成果:
- 由于研究的局限性和异质性,证据质量较低.
- 没有研究评估了长期 (≥1年) 的阿片类药物对慢性疼痛的益处.
- 有关阿片类药物与剂量相关的阿片类药物使用障碍,过量服用和死亡的风险增加.
结论:
- 非阿片类药物治疗是慢性疼痛的首选治疗方法.
- 必须谨慎使用阿片类药物,并制定目标和戒断计划.
- 关键建议包括最低有效剂量,定期重新评估,避免同时服用阿片类药物和二.
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