与在急诊室治疗头痛的阿片类药物处方相关的风险
Hayward Jake1, MacLean Davis2, Rosychuk Rhonda3
1Department of Emergency Medicine (EM), University of Alberta, Canada.
The American journal of emergency medicine
|January 25, 2025
概括
治疗急诊室头痛的阿片类药物处方增加了长期阿片类药物使用和再访的风险,但没有提高疗效. 这些发现表明,阿片类药物不适合在急诊室治疗头痛.
科学领域:
- 紧急医疗 紧急医疗
- 疼痛管理 疼痛管理
- 药物监督 药物监督 药物监督
背景情况:
- 在急诊室 (ED) 治疗头痛时使用阿片类药物是常见的.
- 以前的研究表明,ED阿片类药物处方和不良事件之间存在联系.
研究的目的:
- 评估处方阿片类药物的安全性和有效性,以治疗出现头痛的ED患者.
- 在一年内评估阿片类药物处方和不良结果之间的关联.
主要方法:
- 一项多中心观察队列研究利用了加拿大阿尔伯塔省 (2010-2020) 的相关行政数据.
- 包括在ED中诊断为头痛的患者,用阿片类药物治疗的患者与未经治疗的对照患者匹配,使用倾向评分.
- 主要结局是长期处方阿片类药物使用 (LTU),阿片类药物相关的ED访问/住院治疗或一年内新的阿片类激素治疗 (OAT) 的组合.
主要成果:
- 在323,932次头痛诊所中,5.7%的患者接受了阿片类药物治疗. 阿片类药物治疗与初级复合结局 (NNH=29) 的风险增加1.65倍有关.
- 接受阿片类药物治疗的患者的LTU率较高 (7.7%与4.8%相比),所有原因的ED访问 (20.8%与19.0%相比),住院 (16.7%与14.8%相比) 和7天的ED复查 (aOR=1.61,NNH=21).
- 没有观察到与阿片类药物相关的ED访问/住院或新的OAT启动的显著增加. 阿片类药物的强度和持续时间预测了危害.
结论:
- 治疗ED头痛的阿片类药物处方与再访,住院和长期使用阿片类药物的增加有关.
- 这些不良结果发生在头痛管理有效性没有明显改善的情况下.
- 这些发现挑战了阿片类药物在ED头痛治疗中的实用性,支持向非阿片类药物替代品的转变.
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
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
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
Prescription, Nonprescription and Orphan Drugs
706
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...
706
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
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


