挑战DSM-5阿片类药物使用障碍标准的实用性,用于诊断有问题的处方阿片类药物使用:下一步
Journal of addiction medicine
|June 6, 2025
概括
治疗慢性疼痛的阿片类药物治疗可以导致一个独特的依赖症候群,与阿片类药物使用障碍分开. 认识到这种处方阿片类药物依赖综合征 (PODS) 是改善疼痛患者治疗的关键.
科学领域:
- 疼痛管理 疼痛管理
- 成 药物 药物 药物 药物
- 药理学 药理学是指药理学的学科.
背景情况:
- 治疗慢性疼痛的阿片类药物治疗最初被推广,因为人们相信成是罕见的,可以控制的.
- 目前用于阿片类药物使用障碍 (OUD) 的诊断标准 (DSM-5) 创建了一个二元方法,将OUD患者与没有OUD患者分开.
- 这种二元方法忽视了长期阿片类药物治疗患者的疼痛缓解,阿片类药物奖励和戒断症状之间的复杂相互作用.
研究的目的:
- 提出一个新的综合症,处方阿片类药物依赖综合症 (PODS),与阿片类药物使用障碍 (OUD) 区别.
- 倡导一种更细微的方法来治疗患有治疗失败的患者,使用阿片类药物治疗疼痛.
- 改善慢性疼痛和有问题的阿片类药物使用患者的治疗策略.
主要方法:
- 对长期阿片类药物治疗慢性疼痛的现有临床观察和文献的概念分析和综合.
- 区分由疼痛驱动的阿片类药物使用动机与由依赖或戒断驱动的动机.
- 提出识别处方阿片类药物依赖综合征 (PODS) 的标准和影响.
主要成果:
- 长期的阿片类药物疼痛治疗可以促进依赖综合征 (PODS),难以区分于阿片类药物使用障碍 (OUD).
- 疼痛缓解和阿片类药物戒断之间的区别往往模糊,使患者和处方医生对持续使用阿片类药物的理解复杂化.
- 使用当前OUD标准的二元方法对于在慢性疼痛管理期间经历依赖的患者来说是不够的.
结论:
- 在慢性阿片类药物治疗疼痛期间,一种独特的处方阿片类药物依赖症候群 (PODS) 发生.
- 识别PODS允许定制治疗策略,当标准的疼痛管理或成治疗不理想时.
- 这种概念转变对于改善与疼痛和阿片类药物使用作斗争的数百万人的护理至关重要.
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