持续的术后阿片类药物使用的危险因素:与慢性术后疼痛不同的实体
Sama Ramo1, Stephan Frangakis2, Jennifer F Waljee3,4
1Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
Regional anesthesia and pain medicine
|September 12, 2024
概括
术后持续使用阿片类药物 (PPOU) 和慢性术后疼痛 (CPSP) 是具有重叠风险因素的不同疾病. 未来的研究应该前性地分析患者的结果,以更好地理解和区分PPOU和CPSP.
科学领域:
- 疼痛医学 医学 疼痛医学
- 外科手术的结果
- 药理学 药理学是指药理学的学科.
背景情况:
- 尽管处方减少,阿片类止痛药在美国手术后疼痛中仍然很常见.
- 术后持续使用阿片类药物 (PPOU) 和慢性术后疼痛 (CPSP) 是不同的,但往往混杂的并发症.
- PPOU被定义为手术后3个月以上的阿片类药物使用,而CPSP涉及持续超过预期愈合的疼痛.
研究的目的:
- 审查和区分PPOU和CPSP的风险因素.
- 探索PPOU和CPSP之间的相互关系.
- 确定未来的研究方向,以了解这些条件.
主要方法:
- 这篇叙事综述综合了关于PPOU和CPSP的现有文献.
- 它检查了每个条件的独特和重叠的风险因素.
- 它分析了通常用于PPOU和CPSP研究的框架和数据源.
主要成果:
- 长期性肺炎风险因素包括物质使用障碍,心理健康问题,先前存在的慢性疼痛 (例如背痛) 和特定的手术 (例如膝盖/关节整形手术).
- CPSP的危险因素包括手术类型 (如胸部,乳房),心理健康 (灾难性) 和手术前/后疼痛.
- 当前的研究经常使用不同的框架 (CPSP的生物心理社会,PPOU的社会重点较小) 并依赖于回顾性索赔数据.
结论:
- PPOU和CPSP具有不同的风险概况,尽管一些因素重叠.
- 现有的研究方法和数据限制阻碍了全面的理解.
- 需要进行前性研究,分析患者报告的结果,并同时测量这两种情况,以推进科学理解.
相关概念视频
Opioid Analgesics: Synthetic and Semisynthetic Opioids
251
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...
251
Analgesia and Pain Management
552
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...
552
Opioid Analgesics: Morphine and Other Natural Cogeners
192
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...
192
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
58
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
58
Local Anesthetics: Clinical Application as Epidural Anesthesia
422
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
422
Opioid Receptors: Overview
588
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,...
588


