长效阿片类药物的处方与非癌症慢性疼痛患者的死亡率
Wayne A Ray1, Cecilia P Chung2, Katherine T Murray3
1Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
JAMA
|June 15, 2016
概括
长期治疗非癌症性慢性疼痛的阿片类药物与死亡风险增加有关,即使不仅仅是过量服用. 这项研究强调需要仔细衡量这些药物的益处和危害.
科学领域:
- 治疗疼痛
- 公共卫生
- 药物监督管理
背景情况:
- 长效阿片类药物与过量死亡的增加有关.
- 长期使用阿片类药物可能会增加其他原因的死亡率.
研究的目的:
- 在非癌症慢性疼痛患者中比较长效阿片类药物与替代药物.
- 评估长效阿片类药物在治疗疼痛中的安全性.
主要方法:
- 田纳西州医疗补助病人的回顾性队列研究 (1999-2012).
- 与抗药或循环抗抑郁药相比,用于长期阿片类药物治疗的新发作的倾向性得分匹配.
- 使用死亡证明分析所有原因和特定原因的死亡率.
主要成果:
- 长效阿片类药物治疗与64%的全因死亡风险增加有关 (HR,1. 64).
- 在非医院死亡 (HR,1. 90) 和心血管死亡 (HR,1. 65) 中观察到死亡风险增加.
- 在治疗的前30天内,死亡风险显著增加 (HR,4. 16).
结论:
- 与替代疗法相比,长效阿片类药物与慢性非癌症疼痛患者的全因死亡率增加有关.
- 死亡风险的增加超出了过量死亡,包括心血管原因.
- 这些发现要求在处方长效阿片类药物时仔细考虑风险效益平衡.
相关概念视频
Opioid Analgesics: Synthetic and Semisynthetic Opioids
1.4K
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...
1.4K
Opioid Analgesics: Morphine and Other Natural Cogeners
1.4K
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...
1.4K
Analgesia and Pain Management
2.8K
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...
2.8K
Prescription, Nonprescription and Orphan Drugs
1.4K
Prescription drugs require a prescription from a medical practitioner and can only be obtained from a pharmacy. They have many applications, including treating pain, anxiety, and hypertension.
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
1.4K
Opioid Receptors: Overview
6.1K
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,...
6.1K
Drug Dosing: Obese Patients
332
In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
332

