2016年CDC的阿片类药物指南以及癌症老年人的止痛药处方模式
Rebecca Rodin1, Lihua Li1,2, Karen McKendrick1,2
1Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA network open
|May 7, 2025
概括
2016年CDC的阿片类药物指南导致老年癌症患者的阿片类药物处方减少. 这种转变导致了对特拉马多尔和 gabapentinoids 的使用增加,这些药物在治疗癌症疼痛方面可能不那么安全和有效.
科学领域:
- 在瘤学瘤学.
- 疼痛管理 疼痛管理
- 公共卫生政策 公共卫生政策
背景情况:
- 2016年疾病控制和预防中心 (CDC) 的指导方针建议不要使用阿片类药物治疗慢性非癌症疼痛.
- 这些指导方针对癌症老年人的止痛药处方的影响仍然不清楚,这些老年人通常需要阿片类药物.
研究的目的:
- 调查2016年CDC指南与癌症老年人止痛药处方模式的变化之间的关联.
- 评估关于疼痛管理指南在这个脆弱人群中的意外后果.
主要方法:
- 在医疗保险当前受益者调查 (MCBS) 数据集 (2010-2020) 中使用了中断时间序列分析.
- 包括65岁以上的医疗保险受益者的纵向队列,其诊断的非皮肤癌.
- 对患有晚期癌症或癌症相关疼痛的患者进行了子组分析.
主要成果:
- 在指南发布后,阿片类药物处方率 (典型的阿片类药物,特拉马多尔,布普伦诺芬) 下降.
- 与典型阿片类药物相比,特拉马多尔处方的减少较小,总体增加了11.5%.
- 在指南实施后, gabapentinoid 处方量显著增加了 24.9%.
结论:
- 2016年CDC指南与老年癌症患者的阿片类药物处方减少有关.
- gabapentinoid 使用的显著增加表明疼痛管理策略的潜在转变.
- 对于替代止痛药的安全性和有效性存在担忧,例如用于治疗癌症疼痛的特拉马多尔和 gabapentinoids.
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