2011 加拿大关于安全有效的使用阿片类药物治疗慢性非癌性疼痛的指南（一般人群）

中文标题：

2011 加拿大关于安全有效的使用阿片类药物治疗慢性非癌性疼痛的指南（一般人群）

英文标题：

Canadian guideline for safe and effective use of opioids for chronic noncancer pain

发布机构：

加拿大Michael G. DeGroote国家疼痛中心

发布日期：

2011-04-30

简要介绍：

AbstractObjective To provide family physicians with a practical clinical summary of the Canadian Guideline for Safe andEffective 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 theeffectiveness and safety of opioids for chronic noncancer pain, and drafted a series of recommendations. A panel of49 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 andtramadol) 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 doseand slow upward titration is recommended, with patient education and close monitoring. Physicians should watch forthe development of complications such as sleep apnea. The optimal dose is one which improves function or decreasespain ratings by at least 30%. For by far most patients, the optimal dose will be well below a 200-mg morphineequivalent 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 prescribingis needed to limit potential harms. The new Canadian guideline provides much-needed guidance to help physiciansachieve a balance between optimal pain control and safety.