基于慢性神经病理性疼痛管理的阿片类药物耐受机制、停药策略及多模式非阿片替代疗法的应用

    Application of Opioid Tolerance Mechanisms, Withdrawal Strategies, and Multimodal Non-opioid Alternative Therapies Based on the Management of Chronic Neuropathic Pain

    • 摘要: 当前慢性非癌性疼痛(chronic non-cancer pain,CNCP),特别是慢性神经病理性疼痛的临床管理正处于观念重构的关键时期。长期以来,受癌症疼痛管理阶梯疗法的影响,强效阿片类药物被广泛应用于慢性神经痛的维持治疗。本综述旨在说明在慢性神经病理性疼痛中,应严格限制长期维持使用强效阿片类药物,将药品定位为仅用于爆发性疼痛的低频、紧急救援手段,并最终通过非阿片类药物的混合使用及替代疗法实现去处方化。

       

      Abstract: Currently, the clinical management of chronic non-cancer pain(CNCP), particularly chronic neuropathic pain, is at a critical juncture in terms of conceptual restructuring. For a long time, influenced by the analgesic ladder for cancer pain management, strong opioids had been widely employed for the maintenance treatment of chronic neuropathic pain. This review aims to elucidate that in the context of chronic neuropathic pain, the long-term maintenance use of strong opioids should be strictly restricted. These drugs should be positioned solely as low-frequency, emergency rescue measures for breakthrough pain, and ultimately, deprescribing should be achieved through the combination usage and substitution of non-opioid therapies.

       

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