JAMA：阿片类药物用于慢性非癌痛治疗应慎重

阿片类药物滥用的鉴别诊断和治疗策略

关于阿片类药物长期使用治疗慢性疼痛的有效性和安全性数据非常有限。阿片类药物依从性监测包括尿样检测。当出现意外的尿检结果时是否决定中止阿片类药物处方应用具有临床复杂性。美国波士顿医学中心的DanielP.Alford博士及其同事综述了意外药物尿检结果的合理解释和处理，以及安全的阿片类药物处方实践，发现针对阿片类药物处方的药物尿检结果显示为阴性等不良行为的潜在原因应予以充分调查。后续的阿片类药物处方应基于校正后的风险和获益评估。论文发表于国际权威杂志JAMA 2013年最新一期在线版上。
研究者对长期阿片类药物治疗慢性非癌症病痛的有效性和安全性展开系统性综述。临床治疗推荐往往衍生自一些专业医疗组织如美国病痛学会、美国疼痛医学研究院、国家医学委员会联合会等制定的临床指南。
综述发现，患者知情同意书和患者-处方者同意书是保证患者理解治疗目标和潜在药物风险的重要策略。对于获益和阿片类药物滥用的监视应通过频繁的面对面评估、药物尿检、监测药片数量、在条件允许时综述处方药物监视程序数据完成。
研究者由此得出结论，针对阿片类药物处方的药物尿检结果显示为阴性等不良行为的潜在原因应予以充分调查。后续的阿片类药物处方应基于校正后的风险和获益评估。

与慢性疼痛相关的拓展阅读：

• PLOS GENET:抗高血压药物或可治疗慢性疼痛
• The EMBO J：研究者揭示慢性疼痛中天然蛋白质14-3-3ζ的重要作用
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Chronic back pain with possible prescription opioid misuse.
IMPORTANCE
Data on the effectiveness and safety of long-term opioid therapy for chronic pain are limited. Opioid adherence monitoring includes urine drug testing. Determining whether a patient's opioid prescription should be discontinued after an unexpected urine test result can be clinically complex.
OBJECTIVE
To review safe opioid prescribing practices and appropriate interpretation and management of unexpected urine drug test results.
EVIDENCE REVIEW
Systematic reviews of the effectiveness and safety of long-term opioid therapy for chronic noncancer pain. Clinical management recommendations are derived from clinical guidelines generated by several professional medical organizations including the American Pain Society, the American Academy of Pain Medicine, and the Federation of State Medical Boards.
FINDINGS
Informed consent and patient-prescriber agreements are important strategies to ensure that patients understand treatment goals and potential opioid risks. Monitoring for benefit and opioid misuse is accomplished by having frequent face-to-face assessments, performing urine drug tests, monitoring pill counts, and reviewing prescription drug monitoring program data, when available.
CONCLUSIONS AND RELEVANCE
The underlying causes for worrisome behaviors such as urine drug test results that are negative for the prescribed opioid should be fully investigated. Subsequent opioid prescriptions should be based on the revised risk and benefit assessment.