Depression and Long-Term Prescription Opioid Use and Opioid Use Disorder: Implications for Pain Management in Cancer.
Depression and Long-Term Prescription Opioid Use and Opioid Use Disorder: Implications for Pain Management in Cancer.
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DOI：
10.1007/s11864-022-00954-4
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发表时间：
2022-03
影响因子：
4.3
通讯作者：
Scherrer JF
中科院分区：
文献类型：
--
作者：
Bates N;Bello JK;Osazuwa-Peters N;Sullivan MD;Scherrer JF
预防长期接受阿片类药物治疗的癌症患者的抑郁应在阿片类药物开始前进行抑郁筛查，并在治疗期间进行反复筛查。在权衡慢性癌症疼痛患者中抑郁症和阿片类药物使用障碍的高发病率与在这一人群中研究的循证疗法的缺乏时，患者和临床医生只能在不完美但必要的治疗方案中做出选择。在可能的情况下，我们建议通过合作护理模式聘请精神病学和疼痛/姑息治疗专家，并向所有患有严重抑郁症和癌症疼痛的患者推荐正念和心理治疗。治疗抑郁症的药物应该保留给中度到严重的症状。在选择性5 -羟色胺再摄取抑制剂（SSRIs）或5 -羟色胺和去甲肾上腺素再摄取抑制剂（SNRIs）度洛西汀、文拉法辛或地文拉法辛中，如果患者有明显的神经性疼痛或纤维肌痛，我们推荐艾司西酞普兰/西酞普兰或舍曲林。对于对SSRI/SNRIs无反应或耐受的患者，应考虑使用三环抗抑郁药（TCAs）（考虑去甲替林或地西帕明，它们具有更好的抗胆碱能特征）。现有证据不足以明确推荐哌甲酯或新型药物，如氯胺酮或裸盖菇素，作为癌症相关抑郁和疼痛的辅助治疗。治疗癌症疼痛患者的医生应采取普遍预防措施，以限制非医用阿片类药物使用的风险。应在初次咨询时对患者进行非医疗阿片类药物使用行为筛查，并在治疗期间定期使用非判断方法，以减少耻辱感。对于非医疗阿片类药物使用和阿片类药物使用障碍的高风险患者，可能需要与成瘾专家共同管理。丁丙诺啡和美沙酮是治疗阿片类药物使用障碍的适应症，虽然它们在治疗癌症疼痛患者阿片类药物使用障碍方面还没有系统的研究，但它们确实为癌症疼痛提供了镇痛作用。虽然跨学科团队管理心理压力的方法可能是有益的，但这对于在综合癌症中心以外接受治疗的患者可能是不可能的。
Preventing depression in cancer patients on long-term opioid therapy should begin with depression screening before opioid initiation and repeated screening during treatment. In weighing the high morbidity of depression and opioid use disorder in patients with chronic cancer pain against a dearth of evidence-based therapies studied in this population, patients and clinicians are left to choose among imperfect but necessary treatment options. When possible, we advise engaging psychiatric and pain/palliative specialists through collaborative care models and recommending mindfulness and psychotherapy to all patients with significant depression alongside cancer pain. Medications for depression should be reserved for moderate to severe symptoms. We recommend escitalopram/citalopram or sertraline among selective serotonin reuptake inhibitors (SSRIs), or the serotonin and norepinephrine reuptake inhibitors (SNRIs) duloxetine, venlafaxine, or desvenlafaxine if patients have a significant component of neuropathic pain or fibromyalgia. Tricyclic antidepressants (TCAs) (consider nortriptyline or desipramine, which have better anticholinergic profiles) should be considered for patients who do not respond to or tolerate SSRI/SNRIs. Existing evidence is inadequate to definitively recommend methylphenidate or novel agents, such as ketamine or psilocybin, as adjunctive treatments for cancer-related depression and pain. Physicians who treat patients with cancer pain should utilize universal precautions to limit the risk of non-medical opioid use (non-medical opioid use). Patients should be screened for non-medical opioid use behaviors at initial consultation and at regular intervals during treatment using a non-judgmental approach that reduces stigma. Co-management with an addiction specialist may be indicated for patients at high risk of non-medical opioid use and opioid use disorder. Buprenorphine and methadone are indicated for the treatment of opioid use disorder, and while they have not been systematically studied for treatment of opioid use disorder in patients with cancer pain, they do provide analgesia for cancer pain. While an interdisciplinary team approach to manage psychological stress may be beneficial, this may not be possible for patients treated outside of comprehensive cancer centers.
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影响因子：
4.7
作者：
Grotmol, Kjersti S.;Lie, Hanne C.;Loge, Jon Havard
通讯作者：
Loge, Jon Havard
影响因子：
4.1
作者：
Agin-Liebes, Gabrielle, I;Malone, Tara;Ross, Stephen
通讯作者：
Ross, Stephen
影响因子：
5.8
作者：
Arthur, Joseph;Edwards, Tonya;Bruera, Eduardo
通讯作者：
Bruera, Eduardo
DOI：
10.1177/0269881116675513
发表时间：
2016-12
期刊：
Journal of psychopharmacology (Oxford, England)
影响因子：
--
作者：
Griffiths RR;Johnson MW;Carducci MA;Umbricht A;Richards WA;Richards BD;Cosimano MP;Klinedinst MA
通讯作者：
Klinedinst MA
影响因子：
33.7
作者：
Dowell, Deborah;Haegerich, Tamara M.;Chou, Roger
通讯作者：
Chou, Roger