Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice
Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice
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DOI：
10.1016/j.mayocp.2015.04.003
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发表时间：
2015-06-01
影响因子：
8.9
通讯作者：
Rathmell, James P.
中科院分区：
文献类型：
--
作者：
Berna, Chantal;Kulich, Ronald J.;Rathmell, James P.
人们对风险的日益担忧以及支持长期阿片类药物治疗慢性非癌性疼痛的疗效的证据有限，导致处方医生考虑停止使用阿片类药物。除了明显的成瘾或转移之外，不良反应的存在、镇痛效果减弱、功能和生活质量下降或功能目标缺乏进展都可以证明尝试让患者摆脱长期阿片类药物治疗是合理的。然而，停止阿片类药物治疗往往会因患者的精神合并症和应对技巧不佳以及缺乏正式的处方指南而受到阻碍。本文的目的是回顾现有文献，并为旨在停止长期阿片类药物治疗的从业者提出建议。具体来说，本综述旨在回答以下问题：什么是最佳阿片类药物逐渐减量方案？如何管理缩减所涉及的风险？阿片类药物逐渐减量的替代品有哪些？使用关键词慢性疼痛联合阿片类药物戒断、逐渐减量、断奶和戒毒进行了 PubMed 文献检索。识别并筛选了 695 份文件； 117 项被认为直接相关并被纳入其中。在此文献综述的基础上，本文提出了针对临床实践的基于证据的建议和基于专家的建议。此外，还确定了缺乏证据的领域，为进一步研究提供了机会。 (C) 2015 梅奥医学教育与研究基金会
Increasing concern about the risks and limited evidence supporting the therapeutic benefit of long-termopioid therapy for chronic noncancer pain are leading prescribers to consider discontinuing the use of opioids. In addition to overt addiction or diversion, the presence of adverse effects, diminishing analgesia, reduced function and quality of life, or the absence of progress toward functional goals can justify an attempt at weaning patients from long-term opioid therapy. However, discontinuing opioid therapy is often hindered by patients' psychiatric comorbidities and poor coping skills, as well as the lack of formal guidelines for the prescribers. The aim of this article is to review the existing literature and formulate recommendations for practitioners aiming to discontinue long-termopioid therapy. Specifically, this review aims to answer the following questions: What is an optimal opioid tapering regimen? How can the risks involved in a taper be managed? What are the alternatives to an opioid taper? A PubMed literature search was conducted using the keywords chronic pain combined with opioid withdrawal, taper, wean and detoxification. Six hundred ninety-five documents were identified and screened; 117 were deemed directly relevant and are included. On the base of this literature review, this article proposes evidence-based recommendations and expert-based suggestions for clinical practice. Furthermore, areas of lack of evidence are identified, providing opportunities for further research. (C) 2015 Mayo Foundation for Medical Education and Research