- 期刊
類鴉片藥物治療非癌症慢性疼痛
Opioid Therapy in Chronic Nonmalignant Pain
摘要
類鴉片藥物仍是現今止痛藥品之黃金標的。臨床上，用於手術後疼痛控制及癌症疼痛均已有定論。對於是否應該長期用於治療非癌症慢性頑固性疼痛，則仍有爭議，主要考量在於是否應該作為第一線用藥。類鴉片藥物治療非癌症慢性疼痛其阻礙主要有二：一是其藥理學副作用、依賴性與成癮性、以及所造成的身體與心理功能影響；其二是來自社會的接受度與國家法令的限制。治療慢性疼痛除類鴉片藥以外，其他可能處理方法還包括各種止痛藥物、侵入性手術與技術、及心理和身體功能復健等。一旦其他方法試過後都沒有效，便不應該禁止使用類鴉片藥物。不過到目前為止，對於類鴉片藥物治療非癌症慢性疼痛病人之選擇，甚至治療目的等都尚未有定論。本文介紹治療慢性疼痛使用類鴉片藥之臨床考量、醫病之間的溝通技巧、以及政府法規限制。
並列摘要
Opioids are still the gold standard for pain relief. Clinically, the USC of opioid therapy in postoperative analgesia and cancer pain management is common. Yet its use in chronic nonmalignant pain is controversial. The decision to initiate opioid therapy should be patient-specific and based on the rationale for treatment, the potential for side effect, addition, and regulatory sanction. Barriers to opioid therapy for chronic nonmalignant pains may include two major problems. First are its possible pharmacological side effects, physical dependence, addition, and other physical or psychokgical effects. The other covers the regulation from the government and non-acceptance from the society. Other interventions for chronic intractable pain may include analgesics, invasive procedures, psychological and physical rehabilitations, etc. Opioid therapy should not, however, be withheld in patients with chronic nonmalignant pain when the pain is not relieved by other interventions. In this text, we is ill discuss the management of chronic intractable pain with opioids, its clinical consideration, communicating skills with patients and their families, and legal regulation from the government.