Opioid Pharmacotherapy for Chronic Non-Cancer Pain in the United States: A Research Guideline for Developing an Evidence-Base
Opioid Pharmacotherapy for Chronic Non-Cancer Pain in the United States: A Research Guideline for Developing an Evidence-Base
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DOI：
10.1016/j.jpain.2010.02.019
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发表时间：
2010-09-01
期刊：
影响因子：
4
通讯作者：
Weisner, Constance M.
中科院分区：
文献类型：
--
作者：
Chapman, C. Richard;Lipschitz, David L.;Weisner, Constance M.
本文件报告了跨学科研究和临床专家小组的共识，该小组负责审查阿片类药物用于慢性非癌性疼痛 (CNCP) 的使用并制定未来研究指南。最近，美国越来越多地使用阿片类药物来治疗慢性非癌症疼痛。与阿片类药物使用增加的对比是：1）缺乏支持长期有效性的证据； 2) 处方阿片类药物的滥用不断升级，包括滥用和转移； 3) 多种特征不明的药物不良事件 (ADE) 的发生率和临床显着性的不确定性，包括内分泌功能障碍、免疫抑制和传染病、阿片类药物引起的痛觉过敏和口干症、用药过量、跌倒和骨折以及社会心理并发症。目前证据的主要局限性是：1）由于临床试验的时间框架较短，关于阿片类药物对慢性疼痛患者的长期有效性的证据很少； 2）结果评估不够全面； 3) ADE 的识别和量化不完整。该小组呼吁对问题领域采取战略性跨学科方法，基础科学家和临床医生合作解决紧迫问题并生成全面的证据基础。它在 3 个领域提出了 4 项建议：1）研究长期阿片类药物治疗有效性的研究策略； 2) 证据生成方法的改进； 3) 产生新证据的潜在研究主题。观点：为 CNCP 开阿片类药物的速度超过了与这些干预措施的利弊相关的科学证据的增长速度。迫切需要强有力的证据基础。本指南提供了创建全面证据基础的战略方法，以指导 CNCP 的安全有效管理。 (C) 2010 年，美国疼痛协会
This document reports the consensus of an interdisciplinary panel of research and clinical experts charged with reviewing the use of opioids for chronic noncancer pain (CNCP) and formulating guidelines for future research. Prescribing opioids for chronic noncancer pain has recently escalated in the United States. Contrasting with increasing opioid use are: 1) The lack of evidence supporting long-term effectiveness; 2) Escalating misuse of prescription opioids including abuse and diversion; and 3) Uncertainty about the incidence and clinical salience of multiple, poorly characterized adverse drug events (ADEs) including endocrine dysfunction, immunosuppression and infectious disease, opioid-induced hyperalgesia and xerostomia, overdose, falls and fractures, and psychosocial complications. Chief among the limitations of current evidence are: 1) Sparse evidence on long-term opioid effectiveness in chronic pain patients due to the short-term time frame of clinical trials; 2) Insufficiently comprehensive outcome assessment; and 3) Incomplete identification and quantification of ADEs. The panel called for a strategic interdisciplinary approach to the problem domain in which basic scientists and clinicians cooperate to resolve urgent issues and generate a comprehensive evidence base. It offered 4 recommendations in 3 areas: 1) A research strategy for studying the effectiveness of long-term opioid pharmacotherapy; 2) Improvements in evidence-generation methodology; and 3) Potential research topics for generating new evidence.Perspective: Prescribing opioids for CNCP has outpaced the growth of scientific evidence bearing on the benefits and harms of these interventions. The need for a strong evidence base is urgent. This guideline offers a strategic approach to creating a comprehensive evidence base to guide safe and effective management of CNCP. (C) 2010 by the American Pain Society