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首页> 外文期刊>Canadian family physician >Canadian guideline for safe and effective use of opioids for chronic noncancer pain: Clinical summary for family physicians. Part 1: general population
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Canadian guideline for safe and effective use of opioids for chronic noncancer pain: Clinical summary for family physicians. Part 1: general population

机译：加拿大安全有效使用阿片类药物治疗慢性非癌性疼痛的指南：家庭医生的临床总结。第1部分：一般人群

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Objective To provide family physicians with a practical clinical summary of the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, developed by the National Opioid Use Guideline Group. Quality of evidence Researchers for the guideline conducted a systematic review of the literature on the effectiveness and safety of opioids for chronic noncancer pain, and drafted a series of recommendations. A panel of 49 clinicians from across Canada reviewed the draft and achieved consensus on 24 recommendations. Main message Screening for addiction risk is recommended before prescribing opioids. Weak opioids (codeine and tramadol) are recommended for mild to moderate pain that has not responded to first-line treatments. Oxycodone, hydromorphone, and morphine can be tried in patients who have not responded to weaker opioids. A low initial dose and slow upward titration is recommended, with patient education and close monitoring. Physicians should watch for the development of complications such as sleep apnea. The optimal dose is one which improves function or decreases pain ratings by at least 30%. For by far most patients, the optimal dose will be well below a 200-mg morphine equivalent dose per day. Tapering is recommended for patients who have not responded to an adequate opioid trial. Conclusion Opioids play an important role in the management of chronic noncancer pain, but careful prescribing is needed to limit potential harms. The new Canadian guideline provides much-needed guidance to help physicians achieve a balance between optimal pain control and safety.
机译：目的为家庭医生提供由国家阿片类药物使用指南小组制定的《加拿大安全有效使用阿片类药物治疗慢性非癌痛指南》的实用临床摘要。证据质量该指南的研究人员对阿片类药物治疗慢性非癌性疼痛的有效性和安全性进行了系统的文献综述，并起草了一系列建议。来自加拿大各地的49位临床医生组成的小组对草案进行了审核，并就24条建议达成了共识。主要信息建议在开处方阿片类药物之前筛查成瘾风险。推荐弱阿片类药物（可待因和曲马多）用于对一线治疗没有反应的轻度至中度疼痛。对弱阿片类药物没有反应的患者可以尝试使用羟考酮，氢吗啡酮和吗啡。建议低剂量和缓慢的向上滴定，并进行患者教育和密切监测。医师应注意并发症的发展，例如睡眠呼吸暂停。最佳剂量是一种改善功能或使疼痛等级降低至少30％的剂量。对于大多数患者而言，最佳剂量将远远低于每天200毫克吗啡当量剂量。对于没有对充分的阿片类药物试验产生反应的患者，建议减少剂量。结论阿片类药物在慢性非癌性疼痛的治疗中起着重要的作用，但是需要谨慎的处方以限制潜在的危害。新的加拿大指南提供了急需的指南，以帮助医生在最佳疼痛控制和安全性之间取得平衡。

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