Ingabe uhlelo lwakho lwezokwelapha lungathinteka?
Ngo-March 2016, amaCentral for the Disease Control and Prevention (CDC) ashicilela imihlahlandlela yokubeka ama-opioids ngobuhlungu obungapheli ngaphandle kokwelapha komdlavuza osebenzayo, ukunakekelwa kwe-palliative nokunakekelwa kokuphela kokuphila. Umbiko wekhasi we-90 + ungaba ngaphezu kweziguli eziningi ezingakwazi noma ezifuna ukugaya.
Lezi zihloko zazingenele ukukhathazeka iziguli eziningi ezibuhlungu , ikakhulukazi labo abaye bafinyelela esiphethweni sokuthi imithi abaxhomeke kuyo ekuphuleni ubuhlungu kanye nemfanelo yokuphila kuyoba nzima, uma kungenakwenzeka, ukuthola.
Ngifingqa izincomo ezingezansi futhi ngicela nokuthola imibono evela ku- rheumatologist uScott J. Zashin, MD ukusiza iziguli ze- arthritis ukuthi ziqonde ukuthi iziqondiso zingabathinta kanjani.
Imihlahlandlela ye-CDC yokuchaza ama-opioids for Pain Chronicle
Ngamafuphi, i-CDC yathi iziguli ezinemizwa kufanele zithole ukwelashwa okunikeza izinzuzo ezinkulu kakhulu eziphathelene nezingozi. Kulezi ziguli ezinzima ezihlala isikhathi eside, i-CDC ithi "Nakuba ama-opioids anganciphisa ubuhlungu ngesikhathi sokusebenzisa isikhathi esifushane, ukubuyekezwa kobufakazi obusemtholampilo kubuthola ubufakazi obunganele ukuqinisekisa ukuthi ukucindezeleka kobuhlungu kuqinisiwe nokuthi ngabe umsebenzi noma izinga lokuphila lithuthukisa yini nge-opioid yesikhathi eside ukwelashwa. Nakuba izinzuzo zokukhululeka, ubuhlungu, ukusebenza, kanye nempilo yokuphila okusetshenziselwa ubuhlungu obungapheli isikhathi eside akuqinisekisiwe, izingozi ezihlobene nokusetshenziswa kwe-opioid yesikhathi eside zicacile futhi zibalulekile. " Manje, vumela ukumba ngokujulile.
I-CDC iqoqo izincomo ezingu-12 ezindaweni ezintathu ezizocatshangelwa:
Ukunquma isikhathi sokuqala noma ukuqhubeka ne-opioids for Pain Chronic
1 - Ukwelashwa kwe-Nonpharmacologic kanye ne-non-opioid pharmacologic therapy kunconywa ubuhlungu obungapheli. Odokotela kufanele babheke ukwelashwa kwe-opioid kuphela uma izinzuzo ezilindeleke zombili ubuhlungu kanye nomsebenzi kulindeleke ukuba zidlule kakhulu izingozi kumguli. Uma kusetshenziswe ama-opioid, kufanele kuhlanganiswe ne-nonpharmacologic therapy kanye ne-non-opioid pharmacologic therapy, njengoba kufanelekile.
2 - Ngaphambi kokuqala ukwelapha opioid for ubuhlungu obungapheli, odokotela kufanele basebenzise imigomo yokwelashwa nazo zonke iziguli, kufaka phakathi imigomo engokoqobo yobuhlungu kanye nomsebenzi, futhi kufanele sicabange ukuthi indlela yokwelapha i-opioid izovalwa uma izinzuzo zingapheli izingozi. Ukwelapha i-opioid kufanele kuqhutshwe kuphela uma kunokuthuthukiswa okungokomqondo ebuchosheni ebuhlungu kanye nomsebenzi odlula izingozi zokuphepha kwesiguli.
3 - Ngaphambi kokuqala futhi ngezikhathi ezithile ngesikhathi ukwelashwa kwe-opioid, odokotela kufanele baxoxisane neziguli ezaziwayo nezingozi ezingokoqobo zokwelapha i-opioid, kanye nemithwalo yemfanelo yesiguli kanye nomtholampilo yokuphatha ukwelashwa.
Ukukhethwa kwe-Opioid, Isilinganiso, Isikhathi, Ukulandelwa, Nokunqamula
4 - Uma uqala ukwelapha opioid for ubuhlungu obungapheli, odokotela kufanele banikeze opioids ngokushesha-release esikhundleni opioide-release / eside-acting (ER / LA) opioids.
5 - Lapho i-opioids iqala, odokotela kufanele banikeze umthamo ophansi kakhulu. Odokotela kufanele baqaphe uma beka ama-opioid kunoma yikuphi ukulinganisa, kufanele baphinde bahlole ngokucophelela ubufakazi bezinzuzo ngabanye kanye nezingozi lapho becabanga ukuthi ukwandisa umthamo ku-≥50 we-morphine milligram equivalents (MME) / ngosuku, futhi kufanele ugweme ukwandisa umthamo ku-≥90 MME / ngosuku noma ukucacisa ngokucophelela isinqumo sokuthi umthamo ulinganiselwe ku-≥90 MME / ngosuku.
6 - Ukusetshenziswa kwe-opioid ende isikhathi eside kuqala ngokuphulukisa ubuhlungu obukhulu . Uma i-opioids isetshenziselwa ubuhlungu obukhulu, odokotela kufanele banikeze inani eliphansi kunawo wonke lama-opioid okukhululwa ngokushesha futhi akufanele banikeze ubuningi obuningi kunalokho okudingekayo esikhathini eside kulindeleke ubuhlungu obukhulu okwanele ukufuna i-opioids. Izinsuku ezintathu noma ngaphansi ziyokwanela, kanti izinsuku ezingaphezu kwezingu-7 ngeke zidingeke.
7 - Odokotela kufanele bahlole izinzuzo kanye nokulimaza (imonakalo, ukulimala, noma izenzakalo ezimbi) neziguli ezinyangeni ezi-1 kuya kwezingu-4 zokuqala ukwelashwa kwe-opioid yokuhlunguphazeka okungakazalwa noma ngaphambi kokwandisa umthamo. Odokotela kufanele bahlole izinzuzo kanye nokulimala kokuqhubekayo ukwelashwa neziguli njalo ezinyangeni ezintathu, uma kungenjalo njalo. Uma izinzuzo zingapheli izidakamizwa zokwelapha opioid eqhubekayo, odokotela kufanele bagxile kwezinye izindlela zokwelapha futhi basebenze neziguli ukufaka ama-opioid kumthamo wezansi noma ukuphaphaza nokuyeka ama-opioids.
Ukuhlola Ingozi Nokubhekana Nezikhwama Zokusetshenziswa Kwe-opioid
8 - Ngaphambi kokuqala futhi ngezikhathi ezithile ngesikhathi kuqhubeka ukwelashwa kwe-opioid, odokotela kufanele bahlole izici ezingozini zokulimala okuhlobene ne-opioid. Esikhathini sohlelo lokwelapha, odokotela kumele bahlanganise amasu okunciphisa ingozi, kuhlanganise nokucabangela ukunikeza i-naloxone lapho kunezimo ezandisa ingozi yokudlula ngokweqile kwe-opioid, njengomlando wokudlula ngaphezulu, umlando wokusetshenziswa kwezidakamizwa, ama-opioid ephakeme (i-50 MME / usuku), noma ukusetshenziswa okwenziwa ngokufanayo benzodiazepine, kukhona.
9 - Odokotela kufanele babuyekeze umlando wesiguli wokulawulwa kwezidakamizwa ezilawulwayo usebenzisa idatha yohlelo lokuqapha izidakamizwa zikahulumeni (PDMP) ukuze kunqunywe ukuthi isiguli sithola yini imithi ye-opioid noma inhlanganisela eyingozi embeka engozini enkulu yokudlula ngokweqile. Odokotela kufanele babuyekeze idatha ye-PDMP uma beqala ukwelashwa kwe-opioid yokuhlunguphazeka okungapheli futhi ngezikhathi ezithile ngesikhathi ukwelashwa kwama-opioid ukuhlupheka okungapheli, kusukela kulowo nalowo odokotela kuya ezinyangeni ezintathu.
10 - Uma ubeka i-opioids ngobuhlungu obungapheli, odokotela kumele basebenzise ukuhlolwa kwezidakamizwa zomchamo ngaphambi kokuqala ukwelashwa kwe-opioid futhi bacabangele ukuhlolwa kwezidakamizwa zomchamo okungenani minyaka yonke ukuhlola imithi enqunyiwe kanye neminye imithi elawulwayo imithi kanye nezidakamizwa ezingekho emthethweni.
11 - Odokotela kufanele bagweme ukubeka imithi yobuhlungu be-opioid kanye ne-benzodiazepines ngesikhathi esifanele.
12 - Odokotela kufanele banikeze noma bahlele ukwelashwa okusekelwe ebufakazini (ngokuvamile ukwelashwa okusizwa ngemithi nge-buprenorphine noma i-methadone ngokuhambisana nemithi yokuziphatha) ngeziguli ezine-opioid disorder disorder.
Lokho Okushiwo Yiziqondiso Ezigulini Ze-Arthritis
Umbuzo: Imikhombandlela ye-CDC yokubeka i-opioids ibonakala igxile lapho ukuqala ukwelapha i-opioid esikhaleni esisha esinamabonakaliso obuhlungu. Ingabe kuncoma ukuthi uzame ukwelapha okungenayo i-opioid ngaphambi kokuthatha ama-opioid?
UDkt Zashin: Iziqondiso zincoma ukuthi izifo ezingekho opioid zizame ngaphambi kokubeka ama-opioids ngobuhlungu obungapheli. Imithi engeyona i-opioid yezinhlungu ifaka phakathi, kodwa ayikhawulelwanga, ukwelashwa kokuziphatha okucatshangelwayo, ukwelashwa kwama- comorbidities (njengokucindezeleka nokuphefumula kokulala), nezinye izindlela zokwelapha ezisiza ngobuhlungu obuhlanganisa i- acetaminophen , ama-NSAID , ama- anti-depressants ama- tricylic, njenge-SNRI's (njenge- [ Cymbalta] duloxetine ) nama-anticonvulsants (njenge- [Neurontin] gabapentin). Ama-opioids afanele iziguli ze-arthritis uma kudingeka ukulawulwa ubuhlungu futhi ukwelashwa okujwayelekile uhlobo oluthile lwesifo samathambo noma ezinye izindlela zokwelapha izihlungu akusizi noma kuphikisana.
Umbuzo: Imihlahlandlela igcizelela ukulinganisa izinzuzo nezingozi ze-opioid therapy. Ingabe lokhu kusikisela ukuthi ukuhlolwa kwesiguli ngabanye ngezinzuzo ezihambisana nezingozi kuyadingeka?
UDkt. Zashin: Ukuqaliswa nokwelashwa okuqhubekayo nobuhlungu besiguli ngama-opioid kudinga ukuhlola okuhlukile futhi kuhlolisiswe isidingo sabo sezinambuzane kanye nenani lemithi ebuhlungu enqunyiwe.
Ukuhlolwa kufanele kubukeze izinzuzo ze-opioid therapy, kanye nemiphumela emibi yokwelapha. Imikhombandlela ayikuvimbeli inani lama-opioid udokotela angakwazi ukumisela kodwa yenza izincomo ezilandelayo ngokuphathwa kokwelashwa okungapheli okuzosebenza ezigulini zamasosha ezifo ezibuhlungu obungapheli. Ukuze ubuhlungu obungapheliyo:
- Sebenzisa umthamo ophansi kakhulu.
- Qaphela ngokucophelela ukuthi izinzuzo zingaphezu kwezingozi, ikakhulukazi uma ngabe umthamo ulingana noma ukhulula kuma-MME angu-50 (i-morphine mg equivalents) ngosuku (isib. 50 mg we- hydrocodone [Norco] ngosuku).
- Gwema ukwandisa umthamo ube ngu-90 MME / usuku noma ngaphezulu.
Futhi, iziguli zidinga ukuqonda ukuthi odokotela bazodinga ukubabuyela ehhovisi kungakapheli inyanga eyodwa noma ngokushesha uma beqala i-opioids yokuhlunguphazeka okungapheli-futhi okungenani zonke izinyanga ezintathu kuzo zonke iziguli ezithatha i-opioids.
Umbuzo: Yini enye okufanele isiguli siyiqonde mayelana neziqondiso ezintsha?
UDkt. Zashin: Ukuvivinya kwe- Urine ukuhlola ezinye izinto ezilawulwayo kungalawulwa ngaphambi kokwelashwa kanye nokuvakashelwa okulandelwayo, njengoba inhlanganisela yezidakamizwa nezinye izinto ezilawulwayo (isibonelo, benzodiazepines) zingandisa ingozi yezinkinga, kufaka phakathi kodwa kungagcini izinkinga zokuphefumula ezingase zisongele ukuphila.
Okubalulekile
I-CDC ithi isiqondiso sinikeza izincomo ngokusekelwe ebufakazini obukhona obukhona obuhunyushwe futhi bukwaziswa ngombono wochwepheshe. Ubufakazi besayensi yomtholampilo ekwazisa izincomo ziphansi kwekhwalithi, noma kunjalo. Ukuzisa ukuthuthukiswa kwesikhombiso esizayo, ukucwaninga okwengeziwe kuyadingeka ukugcwalisa izikhala ezibucayi zobufakazi.
Ngokusho kwe-CDC, "Ukubuyekezwa kobufakazi obumba isisekelo salesi sikhombiso kubonisa ngokucacile ukuthi kuningi okumele kufundwe ngokusebenza kahle, ukuphepha, kanye nokusebenza kahle komnotho we-opioid therapy yesikhathi eside. Njengoba kuboniswe iphaneli lobuchwepheshe esikhathini sakamuva i-workshop exhaswe yiNational Institutes of Health ngendima yemithi yobuhlungu e-opioid ekwelapheni ubuhlungu obungapheli, "ubufakazi abukwanele kuzo zonke izinqumo zomtholampilo umhlinzeki okudingeka azenze mayelana nokusetshenziswa kwama-opioids ngobuhlungu obungapheliyo."
Njengoba ubufakazi obusha buba khona, i-CDC ihlela ukuphinde ibuyele isiqondiso sokunquma ukuthi iziphi izikhalazo zobufakazi zivaliwe ngokugcwele ukuze ziqinisekise ukubuyekezwa kwalesi siqondiso. Kuze kube lolo cwaningo oluqhutshwayo, imihlahlandlela yokusebenza emtholampilo kuyodingeka isekelwe ebufakazini obukhona obuhle kanye nombono wochwepheshe.
Lesi siqondiso esithile senzelwe "ukuthuthukisa ukukhulumisana phakathi kodokotela neziguli mayelana nezingozi nezinzuzo ze-opioid therapy for ubuhlungu obungapheli, ukuthuthukisa ukuphepha nokuphumelela kokuphathwa kabuhlungu, nokunciphisa izingozi ezihlobene nokwelashwa kwe-opioid yesikhathi eside, kufaka phakathi ukukhubazeka kokusebenzisa i-opioid , ukudlula ngokweqile, nokufa ", ngokusho kweCDC. I-CDC iphinde ithi "inzibophezele ekuhloleni isiqondiso ekuboneni umthelela wezincomo kumtholampilo (ie, udokotela) kanye nemiphumela yeziguli, kokubili okuhloswe futhi okungavumelekile, nokubukeza izincomo ezibuyekezweni ezizayo uma kuqinisekisiwe."
Umgqa wokugcina: Iziqondiso zenziwa ukuthuthukisa ukusetshenziswa okuphephile kokwelashwa kwe-opioid nokukhomba amacala okusetshenziswa okungalungile. Akuyona yonke imizamo yebhodi yokuqeda ukwelashwa kwe-opioid endaweni efanele yeziguli.
Uma uthatha ama-opioid ngobuhlungu obungapheli, qala ingxoxo nodokotela wakho mayelana nezinzuzo nezingozi kumacala akho ngabanye. Ngisho noma ngabe uke waxoxa nale nkulumo esikhathini esidlule, yenza futhi futhi wenze njalo ngezikhathi ezithile. Ubuhlungu akuyona into e-static-ibuhlungu futhi ingaba ngcono. Ukuxhumana nge-opioids nangenxa yobuhlungu kungumthwalo wabo bobabili udokotela nesiguli.
Imithombo:
Umhlahlandlela we-CDC Wokubhala Opioids for Pain Chronic - United States, 2016. MMWR. Izincomo nemibiko. Mashi 18, 2016. 65 (1); 1-49.
http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm