CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016.
CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016.
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CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
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发表时间：
2016-04-19
期刊：
影响因子：
--
通讯作者：
Chou R
中科院分区：
文献类型：
--
作者：
Dowell D;Haegerich TM;Chou R
初级保健临床医生发现管理慢性疼痛具有挑战性。阿片类药物治疗慢性疼痛的长期疗效的证据有限。阿片类药物的使用与严重的风险有关，包括阿片类药物使用障碍和过量。为初级保健临床医生在积极的癌症治疗、姑息治疗和临终关怀之外治疗患有慢性疼痛的成年患者提供阿片类药物处方建议。疾病控制和预防中心（CDC）更新了2014年关于阿片类药物有效性和风险的系统性综述，并对益处和危害，价值和偏好以及成本进行了补充审查。CDC使用建议评估、开发和评价分级（GRADE）框架来评估证据类型并确定建议类别。证据包括观察性研究或随机临床试验，具有明显的局限性，使用GRADE方法描述为低质量。由于研究数量有限、研究设计的变异性和临床异质性以及研究的方法学缺陷，未尝试进行荟萃分析。没有研究评估阿片类药物对慢性疼痛的长期（≥1年）获益。阿片类药物与风险增加相关，包括阿片类药物使用障碍，过量和死亡，具有剂量依赖性影响。共有12条建议。最重要的是，非阿片类药物治疗是治疗慢性疼痛的首选。阿片类药物应仅在预期疼痛和功能的益处超过风险时使用。在开始使用阿片类药物之前，临床医生应该与患者建立治疗目标，并考虑如果获益不超过风险，将如何停用阿片类药物。当使用阿片类药物时，临床医生应处方最低有效剂量，在考虑将剂量增加到每天50毫克吗啡当量或更多时，应仔细重新评估获益和风险，并尽可能避免同时使用阿片类药物和苯二氮卓类药物。临床医生应每3个月或更频繁地评估患者持续阿片类药物治疗的益处和危害，并在可用时审查处方药监测计划数据，以确定高风险组合或剂量。对于阿片类药物使用障碍患者，临床医生应提供或安排循证治疗，如丁丙诺啡或美沙酮的药物辅助治疗。该指南旨在改善关于阿片类药物治疗慢性疼痛的益处和风险的沟通，提高疼痛治疗的安全性和有效性，并降低与长期阿片类药物治疗相关的风险。
Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose. To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category. Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent affects. There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone. The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.
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影响因子：
4.2
作者：
Banta-Green, Caleb J.;Merrill, Joseph O.;Calsyn, Donald A.
通讯作者：
Calsyn, Donald A.
影响因子：
5.1
作者：
Attal, N.;Cruccu, G.;Nurmikko, T.
通讯作者：
Nurmikko, T.
影响因子：
3
作者：
Bohnert, Amy S. B.;Logan, Joseph E.;Dowell, Deborah
通讯作者：
Dowell, Deborah
影响因子：
6
作者：
Boscarino, Joseph A.;Rukstalis, Margaret;Stewart, Walter F.
通讯作者：
Stewart, Walter F.
长期阿片类药物治疗慢性非癌性疼痛的趋势。
影响因子：
2.6
作者：
Boudreau, Denise;Von Korff, Michael;Rutter, Carolyn M.;Saunders, Kathleen;Ray, G. Thomas;Sullivan, Mark D.;Campbell, Cynthia I.;Merrill, Joseph O.;Silverberg, Michael J.;Banta-Green, Caleb;Weisner, Constance
通讯作者：
Weisner, Constance