A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner's Guide.
A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner's Guide.
复制标题
DOI：
10.4088/pcc.11m01326
复制
发表时间：
2012-01-01
影响因子：
--
通讯作者：
Lin, Elizabeth H B
中科院分区：
文献类型：
--
作者：
Baldini, Angee;Von Korff, Michael;Lin, Elizabeth H B
目的：回顾、综合和总结关于长期阿片类药物治疗非癌症疼痛的不良反应的最新证据，并为初级保健医生提供基于器官系统的指南，以启动和监测接受长期阿片类药物治疗的患者。使用MEDLINE检索2005年至2011年在同行评审期刊上发表的研究，美国医疗保健研究和质量管理局临床指南和证据报告，以及科克伦系统评价数据库。相关引文和专家建议包括在内。数据提取：如果检索词阿片类药物和感兴趣的器官系统在文章的标题，摘要或文本中，则选择研究。考虑的系统包括胃肠道、呼吸系统、心血管系统、中枢神经系统、肌肉骨骼系统、内分泌系统和免疫系统。在1，974篇初步审查的文章中，选择了74篇关于长期使用阿片类药物对该器官系统影响的证据。在这些文章中，有43篇是基于与阿片类药物处方在初级保健setting.DATA综合直接相关的基础上纳入的：进行了定性综述，因为关于阿片类药物特定不良反应的文章数量通常很少，并且不同系统的不良反应的多样性排除了定量分析。通过各种机制，阿片类药物在几个器官系统中引起不良事件。有证据表明，慢性阿片类药物治疗与便秘、睡眠呼吸障碍、骨折、下丘脑-垂体-肾上腺调节障碍和过量有关。然而，在可能与类阿片有关的不良作用方面仍存在重大差距。阿片类药物相关的不良反应可能会导致健康相关的生活质量显着下降，增加health care costs.CONCLUSIONS：慢性阿片类药物治疗可能引起的各种不良反应支持建议，为慢性非癌性疼痛的初级保健医生明智和选择性阿片类药物处方。需要进一步研究阐明慢性阿片类药物治疗的潜在不良反应的风险和管理，以指导临床实践。
OBJECTIVE: Review, synthesize, and summarize recent evidence on adverse effects of long-term opioid treatment for noncancer pain and present an organ system-based guide for primary care physicians in initiating and monitoring patients receiving chronic opioid therapy.DATA SOURCES: A search for studies published in peer-reviewed journals from 2005 to 2011 was conducted using MEDLINE, Agency for Healthcare Research and Quality Clinical Guidelines and Evidence Reports, and the Cochrane Database of Systematic Reviews. Related citations and expert recommendations were included.DATA EXTRACTION: Studies were selected if the search terms opioid and the organ system of interest were in the article's title, abstract, or text. Systems considered were gastrointestinal, respiratory, cardiovascular, central nervous, musculoskeletal, endocrine, and immune. Of 1,974 initially reviewed articles, 74 were selected for evidence regarding effects of chronic opioid use on that organ system. Of these articles, 43 were included on the basis of direct relevance to opioid prescriptions in the primary care setting.DATA SYNTHESIS: A qualitative review was performed because the number of articles pertaining to specific adverse effects of opioids was typically small, and the diversity of adverse effects across systems precluded a quantitative analysis.RESULTS: Through a variety of mechanisms, opioids cause adverse events in several organ systems. Evidence shows that chronic opioid therapy is associated with constipation, sleep-disordered breathing, fractures, hypothalamic-pituitary-adrenal dysregulation, and overdose. However, significant gaps remain regarding the spectrum of potentially opioid-related adverse effects. Opioid-related adverse effects can cause significant declines in health-related quality of life and increased health care costs.CONCLUSIONS: The diverse adverse effects potentially caused by chronic opioid therapy support recommendations for judicious and selective opioid prescribing for chronic noncancer pain by primary care physicians. Additional research clarifying the risks and management of potential adverse effects of chronic opioid therapy is needed to guide clinical practice.