Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.
Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.
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DOI：
10.1016/j.jpain.2008.10.008
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发表时间：
2009-02
期刊：
影响因子：
--
通讯作者：
American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
中科院分区：
文献类型：
--
作者：
Chou R;Fanciullo GJ;Fine PG;Adler JA;Ballantyne JC;Davies P;Donovan MI;Fishbain DA;Foley KM;Fudin J;Gilson AM;Kelter A;Mauskop A;O'Connor PG;Passik SD;Pasternak GW;Portenoy RK;Rich BA;Roberts RG;Todd KH;Miaskowski C;American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
慢性阿片类药物治疗慢性非癌性疼痛的使用大幅增加。美国疼痛协会和美国疼痛医学学会委托对慢性阿片类药物治疗慢性非癌症疼痛的证据进行系统性审查，并召集多学科专家小组审查证据并制定建议。虽然证据有限，但专家小组得出结论，慢性阿片类药物治疗可以是精心选择和监测的慢性非癌症疼痛患者的有效治疗方法。然而，阿片类药物也与潜在的严重危害有关，包括与阿片类药物相关的不良反应和与阿片类药物滥用潜力相关的结局。本文件中提出的建议为以下方面提供了指导：患者选择和风险分层;知情同意和阿片类药物管理计划;慢性阿片类药物治疗的开始和滴定;美沙酮的使用;监测慢性阿片类药物治疗的患者;剂量递增、高剂量阿片类药物治疗、阿片类药物轮换和停止治疗的指征;预防和管理阿片类药物相关的不良反应;驾驶和工作安全;确定医疗之家和何时获得咨询;突发性疼痛的管理;怀孕期间的慢性阿片类药物治疗;以及阿片类药物相关政策。视角：安全有效的慢性阿片类药物治疗慢性非癌性疼痛需要临床技能和知识，包括阿片类药物处方原则以及阿片类药物滥用、成瘾和转移相关风险的评估和管理。尽管在与使用阿片类药物治疗慢性非癌性疼痛相关的许多领域证据有限，但本指南提供了由多学科专家小组在对证据进行系统审查后制定的建议。
Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on chronic opioid therapy for chronic noncancer pain and convened a multidisciplinary expert panel to review the evidence and formulate recommendations. Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. The recommendations presented in this document provide guidance on patient selection and risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; monitoring of patients on chronic opioid therapy; dose escalations, high-dose opioid therapy, opioid rotation, and indications for discontinuation of therapy; prevention and management of opioid-related adverse effects; driving and work safety; identifying a medical home and when to obtain consultation; management of breakthrough pain; chronic opioid therapy in pregnancy; and opioid-related polices. Perspective: Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel following a systematic review of the evidence.
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7.4
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