Alternatives to Opioids in the Pharmacologic Management of Chronic Pain Syndromes: A Narrative Review of Randomized, Controlled, and Blinded Clinical Trials.
Alternatives to Opioids in the Pharmacologic Management of Chronic Pain Syndromes: A Narrative Review of Randomized, Controlled, and Blinded Clinical Trials.
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慢性疼痛综合症药理管理中阿片类药物的替代方法：对随机，控制和盲目临床试验的叙事回顾。
DOI：
10.1213/ane.0000000000002426
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发表时间：
2017-11
影响因子：
5.7
通讯作者：
Benzon HT
中科院分区：
文献类型：
--
作者：
Nicol AL;Hurley RW;Benzon HT
慢性疼痛给个人和社会带来了巨大的负担。如果人们将慢性疼痛视为一种单一的疾病实体，那么它是最常见和最昂贵的医疗条件。目前，建议治疗慢性疼痛患者的医疗专业人员提供综合和多学科的治疗，其中可能包括药物治疗。许多提供者使用非阿片类药物治疗慢性疼痛，然而，对于一些患者来说，阿片类止痛药是慢性疼痛的唯一治疗方法。然而，目前阿片类药物的使用在美国很流行，疾病控制中心(CDC)最近的指导方针建议，只有在某些情况下才能使用阿片类药物治疗非恶性慢性疼痛。这篇综述的目的是报告目前从前瞻性、随机对照、盲法研究中获得的循证医学体系，这些研究涉及使用非阿片类止痛药治疗最常见的非癌症慢性疼痛。在文献检索过程中总共获得了9566项研究，其中271项符合纳入本综述的标准。总体而言，尽管许多非阿片类镇痛剂已被发现对许多慢性疼痛状况有效，但显然缺乏高质量研究的数量，许多研究中指出的效果大小被认为不具有临床意义，尽管具有统计学意义。需要更多的研究来确定对本综述中讨论的慢性疼痛综合征的有效和基于机制的治疗。使用严格和同类的研究方法可能会有更好的一致性和重复性，这在指导循证护理方面是至关重要的。
Chronic pain exerts a tremendous burden on individuals and societies. If one views chronic pain as a single disease entity, then it is the most common and costly medical condition. At present, medical professionals who treat patients in chronic pain are recommended to provide comprehensive and multidisciplinary treatments, which may include pharmacotherapy. Many providers employ non-opioid medications to treat chronic pain, however, for some patients, opioid analgesics are the exclusive treatment of chronic pain. However, there is currently an epidemic of opioid use in the United States, and recent guidelines from the Centers for Disease Control (CDC) have recommended that the use of opioids for non-malignant chronic pain be used only in certain circumstances. The goal of this review was to report the current body of evidence-based medicine gained from prospective, randomized-controlled, blinded studies on the use of non-opioid analgesics for the most common non-cancer chronic pain conditions. A total of 9566 studies were obtained during literature searches and 271 of these met inclusion for this review. Overall, while many non-opioid analgesics have been found to be effective in reducing pain for many chronic pain conditions, it is evident that the number of high-quality studies is lacking and the effect sizes noted in many studies is not considered to be clinically significant despite statistical significance. More research is needed to determine effective and mechanisms-based treatments for the chronic pain syndromes discussed in this review. Utilization of rigorous and homogeneous research methodology would likely allow for better consistency and reproducibility, which is of utmost importance in guiding evidence-based care.