Using placebos as an opioid-sparing method of pain management.
Using placebos as an opioid-sparing method of pain management.
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使用安慰剂作为一种节省阿片类药物的疼痛管理方法。
DOI：
10.1097/j.pain.0000000000000758
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发表时间：
2017
期刊：
影响因子：
7.4
通讯作者：
Waghmarae,Romanth
中科院分区：
文献类型：
--
作者：
Jungquist,CarlaR;Perlis,MichaelL;Waghmarae,Romanth
尽管有潜在的积极方面，这种方法是有争议的，原因有几个：（1）有限的数据表明，该策略是可能的，（2）一些临床医生认为使用安慰剂（在任何应用）不道德和不可接受的患者，（3）行为药物治疗是不能实施的真实的字。虽然第一个问题是可以解决的经验，最后两个可以解决的基础上，目前的实践标准，通过调查病人，并考虑可能是实施的障碍。关于安慰剂使用的伦理问题，Colloca博士等人提出了当前的证据和大量论据，以支持在使用行为药物治疗方法时避免欺骗。关于安慰剂的实际应用，特别是在行为药理学方法中，有两个主要问题：（1）制药业需要为所有具有部分强化适应症的药物生产匹配的安慰剂;（2）药店需要将药物以铝箔包装分发，其中匹配的安慰剂按照预先指定的时间表放置。毫无疑问，这些考虑因素会使制造过程和药房实践“复杂化”，并在药物的生产和分发方面产生额外的成本。然而，相对于该战略的益处而言，这些实际问题可能被认为是为类阿片维持治疗所取得的成果付出的很小代价。此外，行为药理学方法所涉及的成本可能会使行业受益，在药学实践中可以收回，最终甚至可以降低阿片类药物维持治疗的成本。
Despite potential positive aspects, this approach is controversial for several reasons:(1) limited data demonstrating that the strategy is possible,(2) some clinicians consider the use of placebos (in any application) unethical and unacceptable to patients, and (3) behavioral pharmacotherapeutics is not implementable in the real word. Although the first issue is addressable empirically, the last two may be addressed based on current standards of practice, by surveying patients, and by consideration of what the barriers might be for implementation. With respect to the ethics of placebo use, Dr. Colloca et al. presented the current evidence and a substantial argument in support of avoiding deception when using the behavioral pharmacotherapeutics approach. Thus, it is possible that the behavioral pharmacotherapeutic approach could be adopted with patient consent.With respect to the real-world applicability of placebo use, particularly within the behavioral pharmacotherapeutic approach, there are 2 major issues:(1) the pharmaceutical industry would need to manufacture matching placebos for all the medications that have a partial reinforcement indication and (2) pharmacies would need to distribute medication in foil packs where matching placebos are placed in accordance with prespecified schedules. There is no doubt that these considerations would “complicate” the manufacturing process and pharmacy practice and incur additional costs with respect to the production and dispensing of medication. These practical problems, however, when viewed relative to the benefits of the strategy will likely be considered a small price to pay for what is gained with respect to maintenance therapy with opioids. Furthermore, it is likely that the costs involved with the behavioral pharmacotherapeutic approach will benefit industry, be recoverable in pharmacy practice, and ultimately even reduce the costs of maintenance therapy with opioids.