镇痛剂会成瘾致死?AI新疗法可替代阿片类镇痛剂,无成瘾性、安全有效!

2022-08-17 乔维钧 生物探索

慢性疼痛非常常见:包括背痛、骨关节炎、偏头痛等等。由于疼痛,人们会身体长期不适,甚至患上抑郁症。近期有研究发现人工智能提供的新疗法可以止痛,减少患者使用阿片类药物。

慢性疼痛是就诊时医师最常见的病症之一。慢性疼痛可依据疼痛的主要特征或按身体部位分类:肌筋膜性、肌肉骨骼性(机械性)、神经病理性、纤维肌痛和慢性头痛综合征。每3例超过65岁的患者中就有1例存在慢性疼痛,经常是由于关节炎、骨质疏松症伴骨折或腰椎管狭窄所致。老年患者中未经治疗的慢性疼痛可能导致抑郁、低生活质量和独立性丧失。

慢性疼痛的救星通常是依赖阿片类药物,然而阿片类药物中能够有效治疗疼痛的因素同时也是危险因素!

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■ 低剂量的阿片类药物可能会让人感到困倦

■ 高剂量的阿片类药物会减慢呼吸和心率,甚至导致死亡

■ 服用阿片类药物后产生的愉悦感会让人想继续体验这种感觉,这可能会导致镇痛剂使用成瘾。虽然癌症相关疼痛患者的成瘾很少见,但也可能会发生。成瘾感觉就像有一种无法控制的冲动,想要去服用阿片类药物,即使没有疼痛。

谨慎遵循医生指示并严格按照处方服药,可以降低危险副作用的风险。确保医生知道您正在服用的所有其他药物和补充剂。然而人工智能提供的新疗法可以替代阿片类镇痛剂!

现状对于慢性疼痛认知疗法存在难题:由于慢性疼痛的认知行为疗法需要多次治疗且治疗师资源极度稀缺,因此许多患者的问诊受限或无法完成治疗。
 
JAMA Internal Medicine发表的一项最新研究题为“Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: A Randomized Comparative Effectiveness Trial”,研究表明,由人工智能提供的慢性疼痛的认知行为疗法(Cognitive behavioral therapy for chronic pain,CBT-CP)是阿片类镇痛剂的安全有效替代品
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1 研究成果(图源:[1]

临床医生一直主张加强以患者为中心的慢性疼痛患者护理,而这项研究为此做出了贡献。为了确定AI-CBT-CP(人工智能提供慢性疼痛的认知行为疗法)是否是其标准对应物的可行替代方案,研究人员通过随机比较有效性试验,受试者包括来自退伍军人事务部卫生系统的278名慢性背部疼痛患者(招募和数据收集时间为2017年7月11日至2020年4月9日)。与对照组相比,更多的患者被随机分配到AI-CBT-CP组,以最大限度地提高AI系统与患者交互中学习的能力。

所有患者都接受了10周的人工智能提供慢性疼痛的认知行为疗法。对于AI-CBT-CP组,AI引擎使用通过每日交互式语音响应(Interactive voice response,IVR)呼叫的患者反馈,为患者提供45分钟或15分钟的电话会诊参考和患者个性化的诊疗方案。对照组的患者接受了10次由治疗师提供的电话CBT-CP诊疗会话(45 分钟/会话)。

 IVR是一种经常用于客户服务呼叫中心的自动化系统,客户访问没有治疗师在线时候,该系统将预先录制的消息与用户访问时进行回应、互动、传达。

这项随机比较有效性试验结果发现,人工智能提供慢性疼痛的认知行为疗法其结果并不亚于45分钟的电话治疗师课程,而所需的治疗时间却不到电话治疗师时间的一半。在试验进行6个月的时候,更多接受过AI-CBT-CP疗法的患者在身体功能恢复和疼痛强度减弱方面有了显著的改善,此次临床试验意义重大

这项随机试验的结果表明,与普通治疗师提供的CBT-CP 相比,AI-CBT-CP可以实现快速且诊疗效果更好的结果,同时弥补了疼痛问诊量巨大缺口并降低治疗师人工成本。

参考资料:

[1]Piette JD, Newman S, Krein SL, et al. Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: A Randomized Comparative Effectiveness Trial. JAMA Intern Med. 2022 Aug 8. doi: 10.1001/jamainternmed.2022.3178. Epub ahead of print. PMID: 35939288.
[2]https://www.mskcc.org/zh-hans/cancer-care/patient-education/opioids-what-you-need-know

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    2022-08-19 lhlxtx
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    2022-08-19 zhaojie88
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    2022-08-19 kcb074

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