2014年10月16日木曜日

非がん性疼痛へのオピオイド使用:処方時依存症などチェック厳格に

非がん性疼痛へのオピオイド使用


受診毎・毎回モニタリングや依存性チェックなど厳格化すべき


Opioids for chronic noncancer pain
Neurology September 30, 2014 vol. 83 no. 14 1277-1284














  1. Track pain and function at every visit using a brief, validated instrument, so that the practitioner is aware of the effectiveness of opioids at every step
  2. Document the daily MED in mg/d from all sources of opioids at every visit
  3. Access the state PDMP data (a) at the time of a first prescription for opioids, particularly if that visit is to an emergency department; (b) at the time of a decision as to whether to institute COAT; and (c) periodically during monitoring of COAT, with a frequency according to risk of abuse
  4. Screen for past and current substance abuse and for severe depression, anxiety, and posttraumatic stress disorder prior to initiation of COAT
  5. Use random urine drug screening prior to initiation of COAT and periodically during monitoring of COAT, with a frequency according to risk
  6. Use a patient treatment agreement, signed by both the patient and prescriber, that adequately addresses the risks of COAT and the responsibilities of the patient, at the initiation of COAT and annually
  7. Avoid escalating doses above 80–120 mg/d MED unless sustained meaningful improvement in pain and function is attained, and not without consultation with a pain management specialist                         
MED=morphine equivalent dose
COAT=chronic opioid analgesic therapy


0 件のコメント:

コメントを投稿

noteへ実験的移行

禁煙はお早めに! 米国における人種・民族・性別による喫煙・禁煙での死亡率相違|Makisey|note 日常生活内の小さな身体活動の積み重ねが健康ベネフィットをもたらす:VILPA|Makisey|note