Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain

被引：1553

作者：

Chou, Roger ^{[1
]}

Fanciullo, Gilbert J. ^{[2
]}

Fine, Perry G. ^{[3
]}

Adler, Jeremy A. ^{[4
]}

Ballantyne, Jane C. ^{[5
]}

Davies, Pamela ^{[6
]}

Donovan, Marilee I. ^{[7
]}

Fishbain, David A. ^{[8
]}

Foley, Kathy M. ^{[9
]}

Fudin, Jeffrey ^{[10
,11
]}

Gilson, Aaron M. ^{[12
]}

Kelter, Alexander ^{[13
]}

Mauskop, Alexander ^{[14
]}

O'Connor, Patrick G. ^{[15
,16
]}

Passik, Steven D. ^{[17
]}

Pasternak, Gavril W. ^{[18
]}

Portenoy, Russell K. ^{[19
]}

Rich, Ben A. ^{[20
]}

Roberts, Richard G. ^{[21
]}

Todd, Knox H. ^{[22
]}

Miaskowski, Christine ^{[23
]}

机构：

[1] Oregon Hlth & Sci Univ, Dept Med, Dept Med Informat & Clin Epidemiol, Oregon Evidence Based Practice Ctr, Portland, OR 97201 USA

[2] Dartmouth Hitchcock Med Ctr, Dept Anesthesiol, Pain Management Ctr, Lebanon, NH 03766 USA

[3] Univ Utah, Dept Anesthesiol, Pain Res Ctr, Salt Lake City, UT USA

[4] Pacific Pain Med Consultants, Encinitas, CA USA

[5] Massachusetts Gen Hosp, Dept Anesthesia & Crit Care, Div Pain Med, Boston, MA 02114 USA

[6] Seattle Canc Care Alliance, Seattle, WA USA

[7] Kaiser Permanente NW, Pain Management Clin, Portland, OR USA

[8] Univ Miami, Sch Med Neurol Surg & Anesthesiol, Miami, FL USA

[9] Mem Sloan Kettering Canc Ctr, Dept Neurol, Pain & Palliat Care Serv, New York, NY 10021 USA

[10] Samuel S Stratton Dept Vet Affairs Med Ctr, Albany, NY USA

[11] Albany Coll Pharm & Hlth Sci, Albany, NY USA

[12] Univ Wisconsin, Paul P Carbone Comprehens Canc Ctr, Pain & Policy Studies Grp, Madison, WI 53706 USA

[13] Calif Dept Hlth Serv, EPIC Branch, Sacramento, CA USA

[14] New York Headache Ctr, New York, NY USA

[15] Yale Univ, Sch Med, Gen Internal Med Sect, New Haven, CT USA

[16] Yale New Haven Med Ctr, New Haven, CT 06504 USA

[17] Mem Sloan Kettering Canc Ctr, Dept Psychiat & Behav Sci, New York, NY 10021 USA

[18] Mem Sloan Kettering Canc Ctr, Dept Mol Pharmacol & Chem, Lab Mol Neuropharmacol, New York, NY 10021 USA

[19] Beth Israel Deaconess Med Ctr, Dept Pain Med & Palliat Care, New York, NY 10003 USA

[20] Univ Calif Davis, Div Bioeth, Sch Med, Davis, CA USA

[21] Univ Wisconsin, Sch Med & Publ Hlth, Madison, WI 53706 USA

[22] Beth Israel Deaconess Med Ctr, Pain & Emergency Med Inst, New York, NY 10003 USA

[23] Univ Calif San Francisco, Dept Physiol Nursing, San Francisco, CA 94143 USA

来源：

JOURNAL OF PAIN | 2009年 / 10卷 / 02期

关键词：

Clinical practice guideline; opioids; opioid analgesics; risk assessment; monitoring; chronic pain; CHRONIC NONMALIGNANT PAIN; PRIMARY-CARE PHYSICIANS; CONTROLLED-RELEASE OXYCODONE; LONG-TERM TREATMENT; LOW-BACK-PAIN; BREAKTHROUGH PAIN; NEUROPSYCHOLOGICAL PERFORMANCE; METHADONE-MAINTENANCE; BEHAVIORAL TREATMENT; TREATED PATIENTS;

D O I：

10.1016/j.jpain.2008.10.008

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on chronic opioid therapy for chronic noncancer pain and convened a multidisciplinary expert panel to review the evidence and formulate recommendations. Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. The recommendations presented in this document provide guidance on patient selection and risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; monitoring of patients on chronic opioid therapy; dose escalations, high-dose opioid therapy, opioid rotation, and indications for discontinuation of therapy; prevention and management of opioid-related adverse effects; driving and work safety; identifying a medical home and when to obtain consultation; management of breakthrough pain; chronic opioid therapy in pregnancy; and opioid-related polices. Perspective: Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence. (c) 2009 by the American Pain Society

引用

页码：113 / 130

页数：18

共 137 条

[21] A randomized, double-blind, placebo-controlled, cross-over pilot study to assess the effects of long-term opioid drug consumption and subsequent abstinence in chronic noncancer pain patients receiving controlled-release morphine [J].