非癌慢性疼痛病人以精神科藥物配合精神科社區復健活動介入之改善案例

To Improve Pain Control in Non-Malignancy Patients with Psychiatric Medications and Community Psychiatric Rehabilitation

陳曦(Si Chen) ； 劉彥廷(Yen-Ting Liu) ； 呂英豪(Ying-Hao Lu)

《臺灣臨床藥學雜誌》 25卷3期 (2017/07) Pp. 255-261

https://doi.org/10.6168/FJCP.2017.2503.08

摘要

疼痛可分為急性與慢性，慢性疼痛定義為疼痛感持續超過三個月以上。非癌症引起的慢性疼痛一般對非類固醇抗發炎藥物的治療有效。一旦治療效果不佳或較嚴重者，才考慮鴉片類止痛劑。本文探討一名非癌慢性疼痛病人長期使用鴉片類止痛劑及精神科藥物，但未見疼痛問題緩解，加入精神科社區復健活動後，觀察其長期疼痛問題之改善案例。一名49 歲女性，1999 年起因骨關節病變、腰椎間盤移位引起腰痛伴隨有失眠症狀，於2007 年由精神科醫師介入診斷為憂鬱症並開立抗憂鬱劑進行治療，但長期服用未見其疼痛症狀改善，於是2009 年7 月開始使用鴉片類止痛劑。長期觀察該病人使用鴉片類止痛劑用量並未減少，因此2011 年8 月介入精神科社區復健活動治療後發現鴉片類止痛劑使用量明顯漸少，至同年11 月以後停止服用。後續持續觀察病人疼痛及憂鬱症控制情況。由過去案例得知慢性疼痛病人有長期使用鴉片類止痛劑的必要性，長期使用效果不佳時則需懷疑憂鬱症的可能性，並輔以精神科藥物以減少鴉片類止痛劑的使用。此外，藉由此案例得知病人參與精神科社區復健活動可有效改善其疼痛程度。因此非癌慢性疼痛病人長期使用鴉片類止痛劑前，應同時評估精神科用藥與嘗試精神科社區復健活動。

關鍵字

非癌慢性疼痛 ； 鴉片類止痛劑 ； 抗憂鬱劑 ； 精神科社區復健活動

並列摘要

Chronic pain is defined as persistent painful feeling for more than three months. Non-steroidal anti-inflammatory drugs (NSAIDs) are usually effective when applied against non-malignant chronic pain. The opioid is considered to use if no distinct progress is observed. This study case is to be evaluated how community psychiatric rehabilitation involvement provided improvement to a non-malignant chronic pain patient after failure in long-term psychotics and opioids usage. A 49-year-old female had developed insomnia and lower-back pain since 1999. In 2007, despite the patient starting to take antidepressants after been diagnosed as depressive, no pain relief was seen after long-term medication. Opiate (morphine 30 mg/day orally) was then introduced in July 2009; however, there was no reduction in opioid dosage while antidepressants were still being taken simultaneously. Hence, the patient was advised to participate in a community psychiatric rehabilitation program in August 2011. A significant reduction in opioid dosage was observed, which led to discontinuation of opioids in November 2011. Ongoing monitoring on pain and depression was followed up. Long-term opioid use appears essential for chronic pain patients from previous case studies. The possibility of depression should be considered if effectiveness is limited after long-term opioid use. Furthermore, this study indicates if patients participate in community psychiatric rehabilitation programs, pain level can be reduced effectively; hence, it is necessary to evaluate both psychiatric medications and community psychiatric rehabilitation prior to any long-term opioid use for nonmalignant chronic pain patients.

並列關鍵字

Non-Malignant Chronic Pain ； Opioids ； Antidepressants ； Community Psychiatric Rehabilitation