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阿片类药物在癌症疼痛管理中的应用:把握缓解疼痛与成瘾之间的界限

Opioid Use in Cancer Pain Management: Navigating the Line Between Relief and Addiction.

作者信息

Trullols Maite, Ruiz de Porras Vicenç

机构信息

GRET and Toxicology Unit, Department of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, 08028 Barcelona, Spain.

出版信息

Int J Mol Sci. 2025 Aug 1;26(15):7459. doi: 10.3390/ijms26157459.

Abstract

The use of opioids for cancer-related pain is essential but poses significant challenges due to the risk of misuse and the development of opioid use disorder (OUD). This review takes a multidisciplinary perspective based on the current scientific literature to analyze the pharmacological mechanisms, classification, and therapeutic roles of opioids in oncology. Key risk factors for opioid misuse-including psychiatric comorbidities, prior substance use, and insufficient clinical monitoring-are discussed in conjunction with validated tools for pain assessment and international guidelines. The review emphasizes the importance of integrating toxicological, pharmacological, physiological, and public health perspectives to promote rational opioid use. Pharmacogenetic variability is explored as a determinant of treatment response and addiction risk, underscoring the value of personalized medicine. Evidence-based strategies such as early screening, psychosocial interventions, and the use of buprenorphine-naloxone are presented as effective measures for managing OUD in cancer patients. Ultimately, this work advocates for safe, patient-centered opioid prescribing practices that ensure effective pain relief without compromising safety or quality of life.

摘要

使用阿片类药物治疗癌症相关疼痛至关重要,但由于存在滥用风险和阿片类药物使用障碍(OUD)的发展,也带来了重大挑战。本综述基于当前科学文献,从多学科角度分析阿片类药物在肿瘤学中的药理机制、分类和治疗作用。结合经过验证的疼痛评估工具和国际指南,讨论了阿片类药物滥用的关键风险因素,包括精神疾病共病、既往物质使用和临床监测不足。该综述强调整合毒理学、药理学、生理学和公共卫生观点以促进合理使用阿片类药物的重要性。探讨了药物遗传学变异性作为治疗反应和成瘾风险的决定因素,强调了个性化医疗的价值。诸如早期筛查、心理社会干预和使用丁丙诺啡 - 纳洛酮等循证策略被提出作为管理癌症患者OUD的有效措施。最终,这项工作倡导以患者为中心的安全阿片类药物处方实践,确保有效缓解疼痛而不损害安全性或生活质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/883f/12347026/b1a852122857/ijms-26-07459-g001.jpg

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