在非癌症疼痛中长期使用阿片类药物的两阶段住院患者戒断计划
Konrad Streitberger1, Michael A Harnik1, Anna Saliba2
1Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
European journal of pain (London, England)
|March 21, 2025
概括
这项住院治疗计划帮助大多数慢性非癌症疼痛患者停止使用阿片类药物,而不会导致疼痛恶化. 大多数人在三个月内仍然没有阿片类药物,在阿片类药物戒断管理中表现出成功.
科学领域:
- 疼痛医学 医学 疼痛医学
- 成精神病学成精神病学
- 临床心理学 临床心理学
背景情况:
- 高剂量长期阿片类药物治疗慢性非癌症疼痛 (CNCP) 是越来越大的公共卫生挑战.
- 在CNCP患者中,阿片类药物的逐渐减少和戒断是复杂的,并且在门诊环境中往往不成功.
研究的目的:
- 为CNCP患者评估一个结构化的,两阶段的住院阿片类药物戒断 (OW) 计划,这些患者之前的门诊尝试失败了.
- 评估该计划在实现持续停用阿片类药物的安全性和有效性.
主要方法:
- 一项前性观察性研究,涉及38名接受长期阿片类药物治疗的CNCP患者 (≥6个月,每天≥100毫克MED).
- 该计划包括住院患者戒断阶段 (第一阶段),随后是多模式疼痛康复 (第二阶段).
- 测量结果是阿片类药物戒断率 (主要) 和疼痛强度变化 (次要).
主要成果:
- 89%的患者完成了两个阶段;84%的患者在第二阶段后没有阿片类药物.
- 在3个月后,61%的人仍然没有阿片类药物,平均疼痛强度稳定.
- 一名患者在戒药10天后因自杀而死亡;其他不良事件没有详细说明.
结论:
- 两阶段的住院治疗计划有效地促进了CNCP患者的阿片类药物停用,而不会增加疼痛.
- 显著多数人在3个月内实现了持续的阿片类药物戒断,这凸显了该计划的成功.
- 仔细的患者选择和持续的心理支持对于优化阿片类药物戒断结果至关重要.
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