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Chronic pain management in patients with substance use disorders

机译：物质使用障碍患者的慢性疼痛管理

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PURPOSE: To review the evidence and provide a practical guide for the management of chronic pain among patients with substance use disorders. EPIDEMIOLOGY: Chronic pain affects between 24% and 67% of patients with substance use disorders, and is frequently undertreated. REVIEW SUMMARY: The approach to the patient with chronic pain and a prior or active substance use disorder begins with a thorough assessment of the severity and history of past treatments of both conditions, and the presence of psychiatric disorders. Patients benefit the most from combinations of pharmacologic agents, ranging from nonsteroidal anti-inflammatory drugs to antidepressants, neuroleptics, and opioids if needed. Nonpharmacologic interventions play an adjunctive role. When using opioid analgesics, initiating a treatment agreement provides a framework within which opioids can be prescribed in a safe and effective manner. Aberrant drug-taking behavior should be assessed fully as it may signify prescription medication abuse, poorly treated pain, or worsening mental health. TYPE OF AVAILABLE EVIDENCE: Consensus statements and guidelines from specialty organizations, including the American Pain Society, the American Society of Addiction Medicine, and the American Academy of Pain Medicine; unstructured reviews; cross-sectional surveys; prospective cohort studies; randomized trials; meta-analyses. GRADE OF AVAILABLE EVIDENCE: Poor to fair. CONCLUSION: Although more extensive, high-quality evidence is needed to help guide chronic pain management in patients with past or current substance use, physicians can still deliver effective, appropriate care to this group if they adopt a systematic, well thought out approach that takes into consideration our current understanding of the complex interplay between pain and addiction.
机译：目的：审查证据并为药物滥用障碍患者的慢性疼痛管理提供实用指南。流行病学：慢性疼痛影响了24％至67％的物质使用障碍患者，并且经常得到治疗。概述：对患有慢性疼痛和先前或活性物质使用障碍的患者的治疗方法，首先要对过去两种病的治疗的严重程度和病史以及是否存在精神病进行全面评估。患者可以从多种药物组合中受益最大，从非甾体类抗炎药到抗抑郁药，抗精神病药和阿片类药物（如果需要）。非药物干预起辅助作用。当使用阿片类镇痛药时，启动治疗协议提供了一个框架，在该框架内可以安全有效地开具阿片类药物。应充分评估异常的用药行为，因为这可能表示滥用处方药，疼痛治疗不佳或心理健康状况恶化。可用证据的类型：包括美国疼痛学会，美国成瘾医学学会和美国疼痛医学学会在内的专业组织的共识声明和指南;无组织的评论;横断面调查;前瞻性队列研究;随机试验;荟萃分析。可用的证据等级：差强人意。结论：尽管需要更广泛，高质量的证据来指导过去或当前使用药物的患者的慢性疼痛管理，但如果医生采用系统的，经过深思熟虑的方法，他们仍可以为该组患者提供有效，适当的护理考虑到我们目前对疼痛和成瘾之间复杂相互作用的理解。

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