阿片类药物目前用于慢性非癌性疼痛(CNCP),一些患者持续使用阿片类药物进行长期治疗。利益相关者对长期阿片类药物治疗的认识对于提高疼痛治疗的安全性和有效性至关重要。这项研究的目的是探索疼痛专家的观点,病人,和家庭护理人员在CNCP管理中长期使用阿片类药物。
本研究为定性研究,符合COREQ指南。疼痛专家(n=12),患者(n=14),和家庭成员(n=9)通过在Ramathibodi医院疼痛诊所的目的抽样被招募到研究中。记录了半结构化访谈,逐字转录,概念编码,并使用Atlas进行分析。ti8.0.
所有参与者都将阿片类药物描述为疼痛管理的非一线药物。阿片类药物应仅用于严重疼痛,当非阿片类药物治疗和非药物治疗无效时。患者报告说阿片类药物的好处是缓解疼痛,虽然医生和大多数家庭成员强调阿片类药物的使用应改善功能结局.医生和家庭成员对阿片类药物相关的副作用表示担忧,伤害,和不良事件,而患者没有。患者证实,他们将在监督下继续使用阿片类药物进行疼痛管理。然而,内科医生表示,如果患者疼痛缓解或功能改善不能实现,他们将逐渐减少或停止阿片类药物治疗.如果存在潜在的益处,患者和家庭成员都愿意考虑非药物疗法。患者教育,医患/家庭关系,并提出阿片类药物处方政策以加强CNCP管理。
CNCP的长期阿片类药物治疗可能对那些与医生建立了现实治疗目标(缓解疼痛和改善功能)的患者有益。定期监测和评估风险和收益,不良事件,和药物相关的异常行为是必要的。综合多模态多学科疗法和家庭成员合作对于改善CNCP管理也很重要。
Opioids are currently prescribed for chronic non-cancer pain (CNCP), and some patients use opioids continuously for long-term treatment. Stakeholders\' awareness about long-term opioid therapy is essential for improving the safety and effectiveness of pain treatment. The purpose of this
study is to explore the perspectives of pain specialists, patients, and family caregivers about long-term opioid use in CNCP management.
This
study was a qualitative
study and adhered to the COREQ guidelines. Pain specialists (n = 12), patients (n = 14), and family members (n = 9) were recruited to the
study by purposive sampling at the Pain Clinic of Ramathibodi Hospital. Semi-structured interviews were recorded, verbatim transcribed, conceptually coded, and analyzed using Atlas.ti 8.0.
All groups of participants described opioids as non-first-line drugs for pain management. Opioids should be prescribed only for severe pain, when non-opioid pharmacotherapy and non-pharmacological therapies are not effective. Patients reported that the benefits of opioids were for pain relief, while physicians and most family members highlighted that opioid use should improve functional outcomes. Physicians and family members expressed concerns about opioid-related side effects, harm, and adverse events, while patients did not. Patients confirmed that they would continue using opioids for pain management under supervision. However, physicians stated that they would taper off or discontinue opioid therapy if patients\' pain relief or functional improvement was not achieved. Both patients and family members were willing to consider non-pharmacological therapies if potential benefits existed. Patient education, doctor-patient/family relationships, and opioid prescription policies were proposed to enhance CNCP management.
Long-term opioid therapy for CNCP may be beneficial in patients who have established realistic treatment goals (for both pain relief and functional improvement) with their physicians. Regular monitoring and evaluation of the risks and benefits, adverse events, and drug-related aberrant behaviors are necessary. Integrated multimodal multidisciplinary therapies and family member collaborations are also important for improving CNCP management.