在被诊断为脊椎病的老年人中,与 gabapentin 和阿片类药物同时治疗后的死亡率
Laura S Gold1,2, Patrick J Heagerty2,3, Ryan N Hansen4,5
1Department of Radiology, School of Medicine, University of Washington, Seattle, WA, United States.
Pain
|December 16, 2024
概括
在老年人中,将 gabapentin 添加到阿片类疼痛治疗中,与三环抗抑郁药或duloxetine 相比,并没有增加死亡风险. 这项研究发现,这两组人死亡率没有显著差异.
科学领域:
- 药理学 药理学是指药理学的学科.
- 老年医学 老年医学
- 疼痛管理 疼痛管理
背景情况:
- 吸食阿片类药物对公众健康有显著的负面影响.
- 作为一种替代性疼痛管理策略, gabapentin 的处方数量有所增加.
- 与其他药物同时使用阿片类药物需要仔细评估安全性.
研究的目的:
- 为了比较与阿片类药物同时使用 gabapentin 的患者与使用三环抗抑郁药 (TCA) 或与阿片类药物同时使用duloxetine 的患者之间的死亡率.
- 评估同时接受 gabapentin 和阿片类药物治疗的患者出现重大医学并发症的风险.
主要方法:
- 基于人口的,倾向性得分匹配的队列研究,使用2017-2019年与脊柱相关诊断的医疗保险受益人.
- 67,133名接受 gabapentin+阿片类药物治疗的患者与67,133名接受TCA/duloxetine+阿片类药物治疗的患者进行了比较,根据人口统计和临床因素进行了匹配.
- 主要结局:全因死亡率;次要结局:主要的医疗并发症.
主要成果:
- 在 gabapentin+阿片类药物组和TCA/duloxetine+阿片类药物组之间没有观察到死亡率的显著差异 (aHR 0.98 [0.90-1.06],P=0.63).
- 在加巴丁+阿片类药物组 (aHR 1.02 [1.00-1.04],P=0.03) 观察到严重医学并发症风险略有增加.
- 结果在敏感性分析中保持一致,包括更短的随访期和更严格的处方填充要求.
结论:
- 在服用阿片类药物的脊椎相关疼痛的老年人中,添加 gabapentin 与添加TCA或duloksetine 相比,不会增加死亡风险.
- 虽然死亡风险相似,但加巴丁的添加可能与出现重大医疗并发症的风险略高.
- 在这种人群中,加巴丁可被视为与阿片类药物联合处方治疗疼痛时,在死亡率方面是一种安全的替代方案.
相关概念视频
01:20Opioid Analgesics: Morphine and Other Natural Cogeners
179
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...
179
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
578
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
578
01:25Analgesia and Pain Management
496
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...
496
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
219
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...
219
01:17Drugs Affecting GI Tract Motility: Opioids as Antidiarrheal Agents
174
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...
174
01:21Chemotherapy-Induced Nausea and Vomiting: Cannabinoids
201
Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
Two synthetic agonists of THC,...
Two synthetic agonists of THC,...
201