Managing Chronic Pain in Patients with Opioid Dependence.
Managing Chronic Pain in Patients with Opioid Dependence.
复制标题
管理阿片类药物依赖患者的慢性疼痛。
DOI：
10.1007/s40501-014-0015-4
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发表时间：
2014
影响因子：
--
通讯作者：
Lange,Allison
中科院分区：
文献类型：
--
作者：
Liebschutz,Jane;Beers,Donna;Lange,Allison
意见陈述慢性疼痛可能持续数月至数年，并经常因共病的阿片类药物依赖而加剧；因此，为患者和医生设定现实的期望是制定治疗计划的关键一步。慢性疼痛除了躯体病理外，还受到心理、社会和环境因素的影响，因此治疗需要包括的不仅仅是止痛。具体治疗应针对慢性疼痛和成瘾的诱因和后遗症(例如，社会孤立、身体残疾、抑郁、焦虑、肥胖、经济压力、住房不稳定)，并包括多模式干预：心理社会参与、身体活动和调理、减肥、物质使用治疗和药物治疗。心理社会治疗包括循证认知行为治疗、药物滥用治疗小组、12步计划和其他社交活动。身体活动能力和调理能力可以通过理疗、瑜伽或其他锻炼计划来完成，这对于避免功能丧失和负功能螺旋是必不可少的。在肥胖的背景下，饮食和运动相结合可以减轻疼痛，改善功能。药物滥用治疗对于伴有疼痛和阿片依赖的患者是必不可少的。阿片类药物替代疗法可能有一些额外的止痛益处。药物治疗可以帮助减轻疼痛程度，缓解一些复杂的情况，但单独使用时不太可能有效。阿片类止痛药一般不推荐用于阿片类药物依赖患者，因为有效性和高风险的证据混杂。
Opinion statementChronic pain may last for months to years, and is often heightened by co-morbid opioid dependence; setting realistic expectations for both patient and physician is therefore a key step in formulating treatment plans. Chronic pain is influenced by psychological, social and environmental factors in addition to somatic pathology, thus treatment needs to encompass more than just analgesia. The specific treatments should address contributors to and sequelae of chronic pain and addiction (e.g., social isolation, physical disability, depression, anxiety, obesity, financial stress, housing instability) and include multimodal interventions: psychosocial engagement, physical mobility and conditioning, weight loss, substance use treatment, and medications. Psychosocial treatments include evidence-based cognitive behavioral therapies, substance abuse treatment groups, 12-step programs and other social activities. Physical mobility and conditioning can be accomplished with physical therapy, yoga, or other exercise programs, and are essential to avoid loss of function and a negative functional spiral. In the setting of obesity, diet in combination with exercise can decrease pain and improve function. Substance abuse treatment is essential for patients with comorbid pain and opioid dependence. Opioid replacement therapies may have some added analgesic benefit. Medication can help decrease the pain level and alleviate some of the complicating conditions but is unlikely to be effective when used in isolation. Opioid analgesics are generally not recommended in cases of patients with opioid dependence because of mixed evidence for efficacy and high risk.