【IG:Pharmabook】評論

10th pharmacotherapy p.2692(A)臨床上常用morphine或等效narcotic analgesics來治療acute cancer pain crisis(B)在使用non-opioids治療前，需先看是否有肝腎功能不全的狀況，若有則會考慮opioid類治療(C)雖然Opioids常用於慢性非癌症的疼痛，但長期使用的療效與安全性資料相當有限(D)根據Systematic review 看各類型鴉片劑型對breakthrough pain的療效口頰溶片(buccal film)的fantanyl作為突破性疼痛治療效果最好 ref：Breakthrough Cancer Pain: A Systematic Review of Pharmacologic Management | ONS(A)Opioids are often the next step in the management of acute pain and cancer-related chronic pain(B) The World Health Organization (WHO) recommends a three-step ladder approachusing nonopioids as initial treatment and escalating to either “weak” or “strong” opioids based onmild, moderate, or severe pain intensity ratings, respectively. However, patient specific factors (e.g.,renal or liver dysfunction which may limit nonopioid alternatives), may lead clinicians to initiatetherapy with an opioid to optimize pain relief while minimizing adverse effects.(C)Although opioids continue to be commonly utilized in the management of chronic noncancer pain and can be effective for individual patients, limited data is available supporting the long-term safety and efficacy of these agentsThis medication class may also be an effective treatment option in the management of chronic noncancer pain; however, this continues to be increasingly controversial.(D)Transmucosal immediate-release fentanyl (TIRF) was found to have the most evidence for BtCP.(Breakthrough cancer pain)

【一定要一次過 一定可以過】評論

WHO 疼痛處置策略(見下圖)