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Addressing the Critical Gap: Ensuring Urgent Access to Palliative Care Services with Essential Medications in Nepal. 解决关键差距:确保尼泊尔急需基本药物的姑息治疗服务。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-03-05 DOI: 10.1080/15360288.2024.2320384
Rajeev Shrestha, Sunil Shrestha

Palliative care is essential for life-threatening illnesses. However, Nepal still faces significant challenges in accessing primary palliative care services, including required medications, particularly in rural areas. This commentary highlights the need for policies and guidelines to ensure equitable access to palliative care with medicines. While limited studies in Nepal confirmed the demand, challenges persist in rural areas with deficient access to quality healthcare. This article discusses the existing efforts and noteworthy initiatives implemented by healthcare institutions. However, these efforts are currently limited in scale. We recommend including essential palliative care medicines in government healthcare policies, establishing training programs for healthcare professionals, and developing comprehensive policies with detailed field research work to meet the growing demand. Addressing these issues will significantly improve the quality of life for palliative care patients in Nepal.

姑息关怀对于危及生命的疾病至关重要。然而,尼泊尔在获得包括所需药物在内的初级姑息关怀服务方面仍面临巨大挑战,尤其是在农村地区。这篇评论强调了制定政策和指南的必要性,以确保公平地获得姑息关怀药物。虽然尼泊尔的有限研究证实了这一需求,但在无法获得高质量医疗服务的农村地区,挑战依然存在。本文讨论了医疗机构现有的努力和值得关注的举措。然而,这些努力目前规模有限。我们建议将基本姑息关怀药物纳入政府医疗政策,为医疗保健专业人员设立培训项目,并通过详细的实地调研工作制定全面的政策,以满足日益增长的需求。解决这些问题将大大改善尼泊尔姑息关怀患者的生活质量。
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引用次数: 0
Evaluating the Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Patients with Cancer. 评估癌症患者因严重处方类阿片引起呼吸抑制或用药过量的风险指数。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-05-09 DOI: 10.1080/15360288.2024.2348620
Ngozi A Okoroma, Phap Nguyen, Eric J Roeland, Joseph D Ma

The Commercially Insured health Plan Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) is an evidence-based tool to determine serious opioid-induced respiratory depression (OIRD) or overdose risk. The CIP-RIOSORD total score determines a risk class and estimates the probability for an OIRD event within the next 6 months. We performed a single-center, retrospective analysis to determine CIP-RIOSORD baseline scores and the most common predictive factors in patients with cancer. Patients (n = 160) were split into new consultations (n = 83, Group 1) versus the first documented follow-up consultation (n = 77, Group 2). Most patients were Caucasian women with metastatic gastrointestinal cancer. CIP-RIOSORD scores for Group 1 patients were 14.8 ± 15.2 (mean ± SD, risk class 4). Group 2 patients had higher CIP-RIOSORD scores (16.6 ± 14.9, risk class 4). For Group 1, the most common CIP-RIOSORD predictive factors were use of a long-acting opioid formulation (n = 24, 29%) and daily oral morphine equivalent (OME) ≥100 (n = 20, 24%); for Group 2, predictive factors were use of an antidepressant (n = 34, 44%) and a long-acting opioid formulation (n = 27, 35%). Based on the CIP-RIOSORD, there is a 15% probability of experiencing a serious OIRD event or overdose within the next 6 months.

商业保险健康计划用药过量或严重阿片类药物引起的呼吸抑制风险指数(CIP-RIOSORD)是一种循证工具,用于确定严重阿片类药物引起的呼吸抑制(OIRD)或用药过量风险。CIP-RIOSORD 总分可确定风险等级,并估计未来 6 个月内发生 OIRD 事件的概率。我们进行了一项单中心回顾性分析,以确定癌症患者的 CIP-RIOSORD 基线分数和最常见的预测因素。患者(n = 160)分为新就诊患者(n = 83,第 1 组)和首次有记录的随访患者(n = 77,第 2 组)。大多数患者是患有转移性胃肠癌的白种女性。第 1 组患者的 CIP-RIOSORD 评分为 14.8 ± 15.2(平均值 ± SD,风险等级 4)。第 2 组患者的 CIP-RIOSORD 评分更高(16.6 ± 14.9,风险等级 4)。对于第一组,最常见的 CIP-RIOSORD 预测因素是使用长效阿片制剂(24 人,占 29%)和每日口服吗啡当量(OME)≥100(20 人,占 24%);对于第二组,预测因素是使用抗抑郁药(34 人,占 44%)和长效阿片制剂(27 人,占 35%)。根据 CIP-RIOSORD,在未来 6 个月内发生严重 OIRD 事件或用药过量的概率为 15%。
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引用次数: 0
Prevalence of Reluctance to Prescribe Opioids Among Physicians in Oncology Departments: A Descriptive Cross-Sectional Study From Turkey. 肿瘤科医生不愿开具阿片类药物处方的普遍性:土耳其的一项描述性横断面研究。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-05-28 DOI: 10.1080/15360288.2024.2346630
Suna Aşkın Turan, Ayben Yentek Balkanay, Şenay Aydın

Cancer-related pain (CrP) is a significant public health problem, and opioids are the mainstay of CrP treatment. Considering the persistent problem of inadequate treatment of cancer pain in Turkey, the study was conducted to determine the prevalence of reluctance to prescribe opioids among physicians in oncology departments. The descriptive cross-sectional study included oncology residents and residents without oncology specialization in oncology departments. One thousand physicians were invited by e-mail to the Google Forms survey platform. Two hundred and seventy-eight physicians completed the survey and were included, of which 50% (n: 139) were female. More than half (n: 166; 59.7%) of them were oncology subspecialists. The prevalence of reluctance to prescribe opioids was calculated to be 38.1% (n: 106). A significant positive association was found between the factor associated with reluctance to prescribe opioids and fear of opioid use disorder (β = 0.964; 95% CI = 0.362-1.566; p = .002). Reluctance to prescribe opioids was inversely related to the oncology subspecialty (β = -0.878; 95% CI = -1.54 to -0.213; p = 0.010) and education about CrP and opioid management (β = -1.707; 95% CI = -2.404 to -1.009; p = 0.01). Reluctance to prescribe opioids appears to be associated with a lack of knowledge and fear of opioid use disorder.

癌症相关疼痛(CrP)是一个严重的公共卫生问题,而阿片类药物是治疗癌症相关疼痛的主要药物。考虑到土耳其长期存在癌痛治疗不足的问题,本研究旨在确定肿瘤科医生不愿开具阿片类药物处方的普遍程度。这项描述性横断面研究包括肿瘤科住院医师和非肿瘤专业住院医师。研究人员通过电子邮件向一千名医生发出了谷歌表格调查平台的邀请。共有 278 名医生完成了调查,其中 50%(139 人)为女性。半数以上(166 人;59.7%)为肿瘤亚专科医生。据统计,不愿意开阿片类药物处方的比例为 38.1%(人数:106 人)。不愿意开阿片类药物的相关因素与对阿片类药物使用障碍的恐惧之间存在明显的正相关(β = 0.964; 95% CI = 0.362-1.566; p = .002)。不愿意开阿片类药物处方与肿瘤亚专科(β = -0.878;95% CI = -1.54 至 -0.213;p = 0.010)以及有关 CrP 和阿片类药物管理的教育(β = -1.707;95% CI = -2.404 至 -1.009;p = 0.01)成反比。不愿开具阿片类药物处方似乎与对阿片类药物使用障碍缺乏了解和恐惧有关。
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引用次数: 0
Beyond Traditional Pain Relief: A Review of Alternative Analgesics in Myocardial Infarction Patient Management. 超越传统止痛方法:心肌梗塞患者管理中的替代镇痛剂综述》。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-08 DOI: 10.1080/15360288.2024.2304008
Swarali Yatin Chodnekar, Nityanand Jain, Edouard Lansiaux, Deepkanwar Singh Panag, Valdis Gibietis

While morphine is the recommended first-line treatment for pain management in patients with acute coronary syndrome, recent studies have raised concerns about its association with adverse outcomes. Morphine has been found to cause delayed antiplatelet effects, decreased ticagrelor absorption, increased platelet reactivity, and compromised efficacy of dual antiplatelet therapy (DAPT). Alternative analgesics, such as lidocaine, fentanyl, and acetaminophen, have begun to emerge as viable alternatives, each with unique mechanisms and potential benefits. Lidocaine is demonstrated to have superior effects in reducing microvascular obstruction and fewer adverse events compared to fentanyl, despite being less effective in pain reduction. Fentanyl, which shows rapid onset and powerful analgesic properties, may interfere with ticagrelor absorption, potentially affecting platelet inhibition. Acetaminophen, a centrally acting analgesic, emerges as a safer alternative with comparable pain relief efficacy and minimal side effects. The results of multiple clinical trials emphasize the significance of customizing pain management approaches to match individual patient profiles and achieving the optimal balance between pain relief and potential adverse outcomes.

虽然吗啡是急性冠状动脉综合征患者止痛的推荐一线治疗药物,但最近的研究却引起了人们对吗啡与不良后果相关性的担忧。研究发现吗啡会导致抗血小板作用延迟、替卡格雷吸收减少、血小板反应性增加以及双重抗血小板疗法(DAPT)的疗效受损。利多卡因、芬太尼和对乙酰氨基酚等替代镇痛药已开始作为可行的替代药物出现,每种药物都具有独特的机制和潜在的益处。与芬太尼相比,利多卡因在减少微血管阻塞方面效果更佳,不良反应更少,尽管在减轻疼痛方面效果较差。芬太尼起效快,镇痛作用强,但可能会干扰替卡格雷的吸收,从而影响对血小板的抑制作用。对乙酰氨基酚是一种中枢作用镇痛药,是一种更安全的替代药物,镇痛效果相当,副作用极小。多项临床试验的结果表明,根据患者的个体情况定制疼痛治疗方法以及在缓解疼痛和潜在不良反应之间实现最佳平衡具有重要意义。
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引用次数: 0
Subcutaneous Patient-Controlled Analgesia in Home-Based Palliative Care: "It's as Straightforward as Pushing a Button, Right at my Fingertips". 居家姑息治疗中的皮下患者自控镇痛:"就像按下按钮一样简单,就在我的指尖"。
IF 0.9 Q3 ANESTHESIOLOGY Pub Date : 2024-06-01 Epub Date: 2024-02-26 DOI: 10.1080/15360288.2024.2320404
Miguel Julião, Patrícia Calaveiras, Eduardo Bruera, Paulo Faria de Sousa

Subcutaneous patient-controlled analgesia (SCPCA) in home-based palliative care is a potentially valuable option for providing effective pain relief to some patients, particularly when conventional analgesic approaches prove ineffective or are refused. Our case report illustrates the use of SPCA for the management of breakthrough pain in a patient receiving palliative care at home with no improvement after multiple previous treatments. SCPCA was found to be safe and successful. Future research is essential to explore its precise role, appropriate indications, prescription guidelines, and safety considerations across various palliative care contexts.

居家姑息关怀中的皮下患者自控镇痛(SCPCA)是为某些患者提供有效镇痛的潜在重要选择,尤其是在传统镇痛方法被证明无效或遭到拒绝的情况下。我们的病例报告说明了在家中接受姑息治疗的患者在接受了之前的多种治疗后仍无改善的情况下,使用 SCPCA 治疗突破性疼痛的情况。结果发现,SCPCA 是安全和成功的。未来的研究对于探索其在不同姑息关怀背景下的确切作用、适当的适应症、处方指南和安全注意事项至关重要。
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引用次数: 0
The Use of Ketamine for Malignant and Nonmalignant Chronic Pain in Children: A Review of Current Evidence. 氯胺酮治疗儿童恶性和非恶性慢性疼痛:当前证据综述。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2023-11-27 DOI: 10.1080/15360288.2023.2284976
Khaled AlGhamdi, Kim Sadler

Chronic pain in children continues to pose significant challenges. The pharmacological approach most often revolves around trials and errors, expert opinions, and extrapolation of adult study findings. Ketamine is one of the agents used for chronic pain, especially with a neuropathic component. This article aims to provide an overview of its properties and highlight the current evidence for its use in malignant and nonmalignant chronic pain management. A search on the use of ketamine for chronic pain in children up to 18 years of age covering the period from January 1, 2000, to December 14, 2022, was performed through PubMed, Cochrane Library, EBSCO, EBM Review, Wiley, BMJ, Web of Science, Google Scholar, and the Saudi Digital Library. 218 articles were found and 42 underwent full review. Currently, the evidence about ketamine efficacity and safety for chronic pain management is at best of moderate to low quality. The heterogeinity of ketamine infusion protocols and frequent concomitant use of other analgesics make it difficult to draw robust conclusions. The long-term effect of prolonged usage also remains a concern. Nevertheless, with careful monitoring, the drug may be a reasonable choice for malignant and nonmalignant pain management in selected cases, especially for refractory pain not responding to conventional approaches.

儿童慢性疼痛继续构成重大挑战。药理学方法通常围绕着试验和错误、专家意见以及对成人研究结果的推断。氯胺酮是一种用于慢性疼痛的药物,特别是与神经病变成分。本文旨在提供其性质的概述,并强调其在恶性和非恶性慢性疼痛管理中使用的当前证据。通过PubMed、Cochrane图书馆、EBSCO、EBM Review、Wiley、BMJ、Web of Science、Google Scholar和沙特阿拉伯数字图书馆对2000年1月1日至2022年12月14日期间18岁以下儿童使用氯胺酮治疗慢性疼痛的研究进行了检索,共发现218篇文章,其中42篇进行了全面审查。目前,关于氯胺酮治疗慢性疼痛的有效性和安全性的证据最多是中等到低质量的。氯胺酮输注方案的异质性和其他镇痛药的频繁使用使得很难得出可靠的结论。长期使用的长期影响也是一个问题。然而,在仔细的监测下,该药可能是恶性和非恶性疼痛治疗的合理选择,特别是对于传统方法无效的难治性疼痛。
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引用次数: 0
Barriers and Best Practices on the Management of Opioid Use Disorder. 阿片类药物使用障碍管理的障碍和最佳做法。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2023-12-15 DOI: 10.1080/15360288.2023.2290565
Michelle Krichbaum, Daniela Fernandez, Devada Singh-Franco

Opioids refer to chemicals that agonize opioid receptors in the body resulting in analgesia and sometimes, euphoria. Opiates include morphine and codeine; semi-synthetic opioids include heroin, hydrocodone, oxycodone, and buprenorphine; and fully synthetic opioids include tramadol, fentanyl and methadone. In 2021, an estimated 5.6 million individuals met criteria for opioid use disorder. This article provides an overview of the pharmacology of heroin and non-prescription fentanyl (NPF) and its synthetic analogues, and summarizes the literature related to the management of opioid use disorder, overdose, and withdrawal. This is followed by a description of barriers to treatment and best practices for management with a discussion on recent updates and their potential impact on this patient population. This is followed by a description of barriers to treatment and best practices for management with a discussion on recent updates and their potential impact on this patient population.

阿片类药物是指能激动体内阿片受体的化学物质,从而产生镇痛效果,有时还能使人兴奋。阿片类药物包括吗啡和可待因;半合成阿片类药物包括海洛因、氢可酮、羟考酮和丁丙诺啡;全合成阿片类药物包括曲马多、芬太尼和美沙酮。2021 年,估计有 560 万人符合阿片类药物使用障碍的标准。本文概述了海洛因和非处方芬太尼(NPF)及其合成类似物的药理学,并总结了与阿片类药物使用障碍、过量和戒断管理相关的文献。随后介绍了治疗障碍和管理的最佳实践,并讨论了最近的更新及其对这一患者群体的潜在影响。随后介绍了治疗障碍和最佳管理方法,并讨论了最近的更新及其对这一患者群体的潜在影响。
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引用次数: 0
The Impact of a Clinical Pharmacist Practitioner on Perioperative Pain Management for Orthopedic Surgeries. 临床药剂师对骨科手术围手术期疼痛管理的影响。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2024-01-22 DOI: 10.1080/15360288.2023.2299437
Belal Dakroub, Abigail Brooks, Christine M Vartan, Sandra DiScala

The objective of this quality improvement (QI) project was to assess the impact of an evidence based clinical pharmacist practitioner (CPP) model applied to perioperative pain management by integrating a CPP into the perioperative orthopedic surgery clinical pathway. Secondary objective was to assess the effect of CPP pain management service on surgical team satisfaction. This QI project expanded CPP pain management services for patients who were scheduled for an orthopedic surgery. Surgical provider satisfaction of CPP pain management services was assessed through a provider survey. Pain management recommendations by the Pain CPP were implemented 61% (n = 23/38) of the time by the orthopedic surgeon. The impact of the Pain CPP on perioperative pain management was demonstrated by improvement in the Clinically Aligned Pain Assessment Tool, which was similar in patients where CPP recommendations were accepted compared to surgeon only recommended regimens (p = 0.048). Five orthopedic surgical providers responded to our satisfaction survey, 80% (n = 4/5) strongly agree that a pain management CPP should become a permanent member of the care team. Through an evidence-based CPP model we observed a reduction in quantity of opioid prescribed and morphine equivalent daily dose utilized in patients who underwent an orthopedic surgery.

该质量改进(QI)项目旨在评估循证临床药剂师(CPP)模式对围术期疼痛管理的影响,方法是将 CPP 纳入骨科手术围术期临床路径。次要目标是评估 CPP 疼痛管理服务对手术团队满意度的影响。该 QI 项目为计划接受骨科手术的患者扩大了 CPP 疼痛管理服务。手术提供者对 CPP 疼痛管理服务的满意度通过提供者调查进行评估。骨科医生在 61% 的时间(n = 23/38)内执行了疼痛治疗小组提出的疼痛治疗建议。疼痛 CPP 对围术期疼痛管理的影响体现在临床统一疼痛评估工具(Clinically Aligned Pain Assessment Tool)的改善上,在接受 CPP 建议的患者中,疼痛 CPP 的改善效果与只接受外科医生建议方案的患者相似(P = 0.048)。五名骨科手术提供者对我们的满意度调查做出了回应,80%(n = 4/5)的提供者强烈同意疼痛管理 CPP 应该成为医疗团队的永久成员。通过循证 CPP 模式,我们观察到骨科手术患者的阿片类药物处方量和吗啡当量日剂量均有所减少。
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引用次数: 0
Efficacy and Safety of Low Dose Naltrexone for Chronic Pain. 小剂量纳曲酮治疗慢性疼痛的有效性和安全性。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2024-02-01 DOI: 10.1080/15360288.2024.2302550
Madison N Irwin, David A Cooke, Daniel Berland, Vincent D Marshall, Michael A Smith

Naltrexone is a mu-opioid receptor antagonist increasingly used as an analgesic for chronic pain at low doses. This retrospective, observational cohort study was conducted at an academic medical center to evaluate low-dose naltrexone (LDN) efficacy and describe its use in routine clinical practice. Adults receiving LDN, doses <10 mg for ≥1 month, seen at an outpatient pain clinic from January 1, 2014 to April 1, 2022 were included. The primary outcome was change in the Pain, Enjoyment of Life, and General Activity (PEG) score after LDN. Thirty-one patients were included. Median age was 50 years and 71% were female. Median duration of pain at baseline was 5 years. Mean PEG scores were 7.27 ± 1.39 and 6.62 ± 2.04 at baseline and follow-up, respectively. Mean difference was 0.66 (95% CI [0.10-1.21], p = 0.022). Eighty-seven percent (27) of patients discontinued LDN, 52% (16) for lack of benefit, 23% (7) for loss of benefit, 10% (3) for side effects, and 3% (1) for other reasons. Seven (23%) reported side effects. LDN was associated with a statistically significant reduction in PEG in adult chronic pain patients, however the clinical significance is unclear as over 75% of patients discontinued LDN due to lack of benefit.

纳曲酮是一种μ-阿片受体拮抗剂,越来越多地被用作低剂量慢性疼痛的镇痛剂。这项回顾性观察队列研究是在一家学术医疗中心进行的,目的是评估低剂量纳曲酮(LDN)的疗效,并描述其在常规临床实践中的应用。接受低剂量纳曲酮(LDN)治疗的成人,剂量 p = 0.022)。87%(27 人)的患者停用了 LDN,其中 52%(16 人)是因为缺乏疗效,23%(7 人)是因为失去疗效,10%(3 人)是因为副作用,3%(1 人)是因为其他原因。7人(23%)报告了副作用。从统计学角度看,LDN 可显著减少成年慢性疼痛患者的 PEG,但临床意义尚不明确,因为超过 75% 的患者因缺乏益处而停用 LDN。
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引用次数: 0
Data-Based Opioid Risk Review in Patients with Chronic Pain: A Retrospective Chart Review. 慢性疼痛患者中基于数据的阿片类药物风险回顾:回顾性图表回顾。
IF 1.1 Q3 ANESTHESIOLOGY Pub Date : 2024-03-01 Epub Date: 2023-11-29 DOI: 10.1080/15360288.2023.2288109
Joshua Pogue, Lily Lau, Jeffrey Boyer

A retrospective, cohort, single center, chart review was conducted to compare rates of opioid-associated serious adverse events (SAEs) in a patient cohort 6 months before and 6 months after data-based opioid risk review. The primary objective was the composite reduction in opioid-related SAEs including suicide-related events and opioid overdoses. The impact of the reviews was assessed via multivariate logistic regression and a McNemar's test to analyze difference in rates of opioid-associated SAEs. This study demonstrates that data-based opioid risk review can reduce opioid-related SAEs, opioid overdoses, and suicide-related events in the 6 months post-review. The primary outcome was not statistically significant with a p-value of 0.080. In the population that underwent opioid tapers, the hazard ratios (HR) for suicide-related events and opioid-related SAEs were 6.64 (1.09-40.53, p = 0.05) and 10.43 (0.48-226.80, p = 0.02) respectively when compared to non-tapered patients. The HR for suicide-related events and opioid-related SAEs when opioid therapy was discontinued were 9.95 (2.16-45.94, p = 0.009) and 15.64 (1.09-225.19, p = 0.001) respectively when compared to continuation of opioids. This study showed that data-based opioid risk review may reduce incidence of opioid-related SAEs in patients with chronic pain. Additionally, opioid tapers and discontinuations are significant risk factors for suicide-related events and opioid-related SAEs.

采用回顾性、队列、单中心、图表回顾的方法,比较阿片类药物相关严重不良事件(SAEs)在基于数据的阿片类药物风险评估前6个月和后6个月的患者队列发生率。主要目标是综合减少阿片类药物相关的SAEs,包括自杀相关事件和阿片类药物过量。通过多变量逻辑回归和McNemar检验来评估评价的影响,以分析阿片类药物相关的SAEs发生率的差异。本研究表明,基于数据的阿片类药物风险审查可以在审查后6个月内减少阿片类药物相关的SAEs、阿片类药物过量和自杀相关事件。主要结局无统计学意义,p值为0.080。在接受阿片类药物减少治疗的人群中,与未接受阿片类药物减少治疗的患者相比,自杀相关事件和阿片类药物相关SAEs的风险比(HR)分别为6.64 (1.09-40.53,p = 0.05)和10.43 (0.48-226.80,p = 0.02)。与继续阿片类药物治疗相比,停止阿片类药物治疗时自杀相关事件和阿片类药物相关SAEs的HR分别为9.95 (2.16-45.94,p = 0.009)和15.64 (1.09-225.19,p = 0.001)。本研究表明,基于数据的阿片类药物风险评估可能会降低慢性疼痛患者阿片类药物相关SAEs的发生率。此外,阿片类药物减少和停药是自杀相关事件和阿片类药物相关SAEs的重要危险因素。
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引用次数: 0
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Journal of Pain & Palliative Care Pharmacotherapy
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