American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I--evidence assessment.-猫眼课题宝

DOI：

发表时间：

2012

期刊：

Pain physician

影响因子：

3.7

通讯作者：

中科院分区：

医学2区

文献类型：

作者：

L. Manchikanti;S. Abdi;S. Atluri;Carl C Balog;Ramsin M. Benyamin;M. Boswell;K. Brown;B. Bruel;D. Bryce;Patricia A Burks;A. Burton;Aaron Calodney;D. Caraway;Kimberly A. Cash;P. Christo;K. Damron;Sukdeb Datta;T. Deer;S. Diwan;I. Eriator;F. Falco;B. Fellows;S. Geffert;C. Gharibo;Scott E. Glaser;J. Grider;Haroon Hameed;M. Hameed;Hans C. Hansen;Michael E. Harned;S. Hayek;S. Helm;J. Hirsch;J. Janata;A. Kaye;A. Kaye;D. Kloth;D. Koyyalagunta;Marion O Lee;Y. Malla;Kavita N. Manchikanti;Carla D. McManus;V. Pampati;Allan T. Parr;R. Pasupuleti;V. Patel;N. Sehgal;S. Silverman;V. Singh;H. Smith;Lee T Snook;D. Solanki;D. Tracy;R. Vallejo;Bradley W. Wargo

背景自20世纪90年代以来，阿片类药物滥用继续以惊人的速度增长.根据不同医学专业、医学委员会、倡导团体和缉毒局的记录，现有证据表明，慢性非癌症疼痛中90天或更长时间的慢性阿片类药物治疗存在很大差异。第1部分描述了证据评估。美国介入疼痛医师协会（ASIPP）发布的阿片类药物指南的目的是为阿片类药物治疗慢性非癌症疼痛提供指导，在所涉及的许多不同群体中应用阿片类药物理念时保持一致，改善慢性非癌症疼痛的治疗，并减少滥用和药物转移的发生率。这些指南的重点是减少阿片类药物的滥用，而不危害阿片类药物的非癌症疼痛管理。结果：1）有充分的证据表明阿片类药物的非医疗使用是广泛的;三分之一的慢性疼痛患者可能不按处方使用阿片类药物或可能滥用阿片类药物，这些患者的非法药物使用率明显较高。2)有充分的证据表明，阿片类药物处方正在迅速增加，因为大多数处方来自非疼痛医生，许多患者正在服用长效阿片类药物，许多患者被提供长效和短效阿片类药物的组合。3)有充分的证据表明，阿片类药物供应的增加，高剂量阿片类药物的使用，医生购物者和具有多种共病因素的患者导致了大多数死亡。4)有公平的证据表明，长效阿片类药物以及长效和短效阿片类药物的组合导致死亡率增加，即使是每日吗啡等效剂量40 mg或50 mg的低剂量也可能导致急诊室入院过量和死亡。5)有充分的证据表明，大约60%的死亡病例来自指南中规定的阿片类药物，大约40%的死亡病例发生在10%的药物滥用者中。6)阿片类药物的短期有效性是公平的，而阿片类药物的长期有效性是有限的，因为缺乏长期（> 3个月）高质量的研究，有公平的证据，长效和短效阿片类药物之间没有显着差异。7)在单个药物中，由于缺乏高质量的研究，大多数阿片类药物在短期内有公平的证据，而在长期内的证据有限。8)长期阿片类药物治疗老年慢性非癌性疼痛的有效性和安全性的证据在短期内是公平的，由于缺乏高质量的研究，长期的证据有限;由于缺乏高质量的研究，儿童和青少年以及患有共病心理障碍的患者的证据有限;孕妇的证据不足。9)由于缺乏高质量的研究，阿片类药物滥用筛查测试的可靠性和准确性的证据有限。10)有公平的证据支持通过尿液药物检测和处方药监测项目识别不依从或滥用处方药或非法药物的患者，这两种方法都可以减少处方药滥用或医生购物。免责声明本指南基于最佳可用证据，并不构成僵化的治疗建议。由于证据不断变化，本文件并非旨在作为“标准治疗”。"

BACKGROUND Opioid abuse has continued to increase at an alarming rate since the 1990 s. As documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration, available evidence suggests a wide variance in chronic opioid therapy of 90 days or longer in chronic non-cancer pain. Part 1 describes evidence assessment. OBJECTIVES The objectives of opioid guidelines as issued by the American Society of Interventional Pain Physicians (ASIPP) are to provide guidance for the use of opioids for the treatment of chronic non-cancer pain, to produce consistency in the application of an opioid philosophy among the many diverse groups involved, to improve the treatment of chronic non-cancer pain, and to reduce the incidence of abuse and drug diversion. The focus of these guidelines is to curtail the abuse of opioids without jeopardizing non-cancer pain management with opioids. RESULTS 1) There is good evidence that non-medical use of opioids is extensive; one-third of chronic pain patients may not use prescribed opioids as prescribed or may abuse them, and illicit drug use is significantly higher in these patients. 2) There is good evidence that opioid prescriptions are increasing rapidly, as the majority of prescriptions are from non-pain physicians, many patients are on long-acting opioids, and many patients are provided with combinations of long-acting and short-acting opioids. 3) There is good evidence that the increased supply of opioids, use of high dose opioids, doctor shoppers, and patients with multiple comorbid factors contribute to the majority of the fatalities. 4) There is fair evidence that long-acting opioids and a combination of long-acting and short-acting opioids contribute to increasing fatalities and that even low-doses of 40 mg or 50 mg of daily morphine equivalent doses may be responsible for emergency room admissions with overdoses and deaths. 5) There is good evidence that approximately 60% of fatalities originate from opioids prescribed within the guidelines, with approximately 40% of fatalities occurring in 10% of drug abusers. 6) The short-term effectiveness of opioids is fair, whereas the long-term effectiveness of opioids is limited due to a lack of long-term (> 3 months) high quality studies, with fair evidence with no significant difference between long-acting and short-acting opioids. 7) Among the individual drugs, most opioids have fair evidence for short-term and limited evidence for long-term due to a lack of quality studies. 8) The evidence for the effectiveness and safety of chronic opioid therapy in the elderly for chronic non-cancer pain is fair for short-term and limited for long-term due to lack of high quality studies; limited in children and adolescents and patients with comorbid psychological disorders due to lack of quality studies; and the evidence is poor in pregnant women. 9) There is limited evidence for reliability and accuracy of screening tests for opioid abuse due to lack of high quality studies. 10) There is fair evidence to support the identification of patients who are non-compliant or abusing prescription drugs or illicit drugs through urine drug testing and prescription drug monitoring programs, both of which can reduce prescription drug abuse or doctor shopping. DISCLAIMER The guidelines are based on the best available evidence and do not constitute inflexible treatment recommendations. Due to the changing body of evidence, this document is not intended to be a "standard of care."

American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I--evidence assessment.

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