Opioids and the treatment of chronic pain: controversies, current status, and future directions.
Opioids and the treatment of chronic pain: controversies, current status, and future directions.
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阿片类药物和慢性疼痛的治疗：争议，当前状态和未来方向。
DOI：
10.1037/a0013628
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发表时间：
2008-10
影响因子：
2.3
通讯作者：
Portenoy RK
中科院分区：
文献类型：
--
作者：
Rosenblum A;Marsch LA;Joseph H;Portenoy RK
几千年来，阿片类药物一直被认为是治疗疼痛最有效的药物之一。在世界大多数国家，将其用于治疗与晚期医学疾病相关的急性重度疼痛和慢性疼痛被视为标准治疗。相比之下，长期给予阿片类药物治疗慢性非癌症疼痛仍然存在争议。几十年来，人们对有效性、安全性和滥用责任的担忧不断发展，有时会导致更严格的观点，有时会导致更愿意支持这种治疗。在美国，过去几十年的特点是，由于临床和流行病学观察以及法律的和监管界的事件，人们的态度一再发生变化。类阿片提供镇痛的合法医疗用途与滥用和成瘾相关现象之间的相互关系继续对临床界构成挑战，导致对这些药物在治疗疼痛方面的适当作用存在不确定性。这种叙述性的审查简要介绍了阿片类药物的神经生物学，然后集中在镇痛和滥用之间的接口，包括术语，临床挑战，并为新的代理商，如丁丙诺啡，影响实践的潜力复杂的问题。
Opioids have been regarded for millennia as among the most effective drugs for the treatment of pain. Their use in the management of acute severe pain and chronic pain related to advanced medical illness is considered the standard of care in most of the world. In contrast, the long-term administration of an opioid for the treatment of chronic non-cancer pain continues to be controversial. Concerns related to effectiveness, safety, and abuse liability have evolved over decades, sometimes driving a more restrictive perspective and sometimes leading to a greater willingness to endorse this treatment. The past several decades in the United States have been characterized by attitudes that have shifted repeatedly in response to clinical and epidemiological observations, and events in the legal and regulatory communities. The interface between the legitimate medical use of opioids to provide analgesia and the phenomena associated with abuse and addiction continues to challenge the clinical community, leading to uncertainty about the appropriate role of these drugs in the treatment of pain. This narrative review briefly describes the neurobiology of opioids and then focuses on the complex issues at this interface between analgesia and abuse, including terminology, clinical challenges, and the potential for new agents, such as buprenorphine, to influence practice.
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影响因子：
7.4
作者：
Butler, Stephen F.;Budman, Simon H.;Jamison, Robert N.
通讯作者：
Jamison, Robert N.
影响因子：
4.7
作者：
COMPTON, MA
通讯作者：
COMPTON, MA
影响因子：
6
作者：
Brennan, PL;Schutte, KK;Moos, RH
通讯作者：
Moos, RH
影响因子：
4.2
作者：
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通讯作者：
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影响因子：
7.4
作者：
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通讯作者：
Funesti-Esch, J