Ko chirongwa chako chekurapa chichagadziriswa here?
Muna March 2016, Centers for Disease Control and Prevention (CDC) yakabudisa mirayiridzo yekutsanangura maopioid ekurwadziwa kusingaperi kwekenza yakarapwa kurapwa, kuchengetwa kwepfungwa, uye kuguma kwehupenyu. Ipepanhau re 90+ ringangodarika kupfuura varwere vazhinji vanogona kana kuti vanoda kugadzira.
Musoro wacho wakanga wakakwana kuti uzvidye mwoyo vazhinji varwere vasingaperi vanorwara asi, kunyanya avo avo vakagumburwa kusvika pakuguma kuti mishonga yavanovimba nemarwadzo ekurwadziwa uye hupenyu hwehupenyu hwaizova zvakaoma, kana zvisingaiti, kuwana.
Ndapfupikisa mazano ari pasi apa uye ndakakumbirawo mazano kubva kune rheumatologist Scott J. Zashin, MD kuti vabatsire varwere veArthritis kunzwisisa kuti mirayiridzo inogona kuvakanganisa sei.
CDC Zvinyorwa zvekutsanangura maOpioid for Chronic Pain
Muchidimbu, CDC yakataura kuti varwere vane marwadzo vanofanira kugamuchira kurapwa kunopa zvikomborero zvakakura maererano nehungwaru. Kwemazuva mazhinji kwenguva refu varwere vanorwadziwa, CDC inoti "Kunyange zvazvo opioid inogona kuderedza marwadzo munguva pfupi yekushandiswa kwenguva refu, kubvunzurudza kwehupi hwehupiki hunoona hupupuriro husina kukwana kuti uone kana kurwadziwa kwepfungwa kunotsigirwa uye kana basa kana hutano hwehupenyu hunovandudzika nehupenyu hurefu kwenguva refu Izvozvo apo ruzivo rwekununurwa kunorwadza, basa, uye hupenyu hwehupenyu hurefu hwemaawa epioid kushungurudza kusingaperi hazvizivikanwe, njodzi dzinobatanidza nekushandiswa kwenguva refu kweopioid zvakajeka uye zvinokosha. " Iye zvino, rega kutsva zvakadzika.
ICDC yakatora mazano gumi nemaviri muzvikamu zvitatu zvekufungisisa:
Kusarudza Nguva Yokutanga Kana Kuenderera Mberi yeOpioids for Chronic Pain
1 - Nonpharmacologic therapy uye kwete-opioid pharmacologic therapy inoshandiswa mukurwadziwa kusingaperi. Vanachiremba vanofanirwa kuongorora chirwere che opioid chete kana zvinotarisirwa kuti zvibatsire zvose zvinorwadza uye basa zvinotarisirwa kupfuurira kune ngozi kune murwere. Kana maopioid anoshandiswa, anofanira kunge akabatanidzwa ne-nonpharmacologic therapy uye kwete-opioid pharmacologic therapy, sezvakakodzera.
2 - Usati watanga chirwere cheopioid yekutambudzika kusingaperi, vanachiremba vanofanira kutanga vavariro dzekurapa nevarwere vose, kusanganisira zvinangwa zvekurwadziwa uye basa, uye vanofanira kufungisisa kuti opioid therapy icharegwa sei kana zvikwereti zvisinganyanyi kukosha. Opioid therapy inofanira kupfuurirwa chete kana kune hutano hwakakosha huri nani mukurwadziwa uye basa iro rinowedzera njodzi kune kuchengeteka kwevarwere.
3 - Usati watanga uye nguva nenguva munguva yeipioid therapy, vanachiremba vanofanira kukurukura nevarwere vanozivikanwa nezvengozi uye zviitiko zvechokwadi zveipioid therapy, uyewo varwere uye varapiki mabasa ekutarisa kurapwa.
Opioid Selection, Dosage, Nguva, Kutarisa, uye Kurambidza
4 - Paunotanga chirwere cheipioid nekurwadziwa kusingaperi, vanachiremba vanofanira kupa maopioid pakarepo-kusunungurwa-kubudiswa-kusunungurwa / kwenguva refu (ER / LA) opioids.
5 - Kana maopioid paanotanga, vanachiremba vanofanirwa kupa mutemo wepasi. Vanachiremba vanofanira kushandira pavanorayira maopioid pane chero dhigiriji, vanofanira kunyatsorongedza uchapupu hwezvimwe zvikomborero uye njodzi pavanenge vachifunga nezvekuwedzera kuwedzerwa kune ≥50 morphine milligram yakaenzana (MME) / zuva, uye havafaniri kuwedzera kuwedzerwa ku ≥90 MME / zuva-kana kunyatsoruramisa chisarudzo chekuisa mutero ku ≥90 MME / zuva.
6 - Kushandiswa kwemaawa akawanda kwenguva refu inotanga nekurapa kurwadziwa kwakanyanya . Apo opioid inoshandiswa pakurwadziwa kwakanyanya, vanachiremba vanofanirwa kurongedza nhamba yakadzika yepamusoro yeopioid yekurumidza kusunungurwa uye haafaniri kupa mhuru yakawanda kupfuura iyo inotarisirwa kwenguva yakatarwa yekutambudzika kwakanyanya kunotoda opioid. Mazuva matatu kana zvishoma zvichange zvakakwana, asi mazuva anopfuura 7 haawanzodiwi.
7 - Vanachiremba vanofanirwa kuongororwa zvinobatsira uye zvinokuvadza (kukuvara, kukuvara, kana zviitiko zvinotambudza) nevarwere mukati memakore masere kusvika kumakumi mana okutanga opioid therapy nokuda kwekutambudzika kusingaperi kana kuti kuwedzera chiremba. Vanachiremba vanofanirwa kuongororwa kubatsira uye kuipa kwekuenderera mberi kurapwa nevarwere kwemwedzi mitatu, kana zvisingawanzoitiki. Kana zvikwereti zvisingaiti zvakanyanya kukuvadza kwekuenderera mberi kweapioid therapy, vanachiremba vanofanirwa kuisa pfungwa kune dzimwe nzira dzokurapa uye kushanda nevarwere kuti vawedzere opioid kumutero wakaderera kana kuti taper uye kurega opioid.
Kuongorora Njodzi uye Kutaura Nezvipembenene zveApioid Use
8 - Usati watanga uye nguva nenguva pakuenderera mberi kweapioid therapy, vanachiremba vanofanira kuongorora zviitiko zvinowanzokonzera maitiro ane chokuita neopioid. Mukati peurongwa hwekurapa, vanachiremba vanofanirwa kusanganisira nzira dzokuderedza dambudziko, kusanganisira kuongorora kupa anixone kana zviitiko zvinowedzera ngozi yekuwedzerwa kweopioid, yakadai sedhau rekudarika, nhoroondo yekushandisa zvinodhaka, kuwedzerwa opioid dosages (≥50 MME / zuva), kana kushandiswa kwebenzodiazepine pamwe chete, varipo.
9 - Vanachiremba vanofanira kuongorora nhoroondo yevarwere yekuchengetedzwa kwezvinhu zvinoshandiswa kushandisa hurongwa hwehutano hwemishonga yekuongorora zvirongwa (PDMP) kuti uone kana murwere ari kugamuchira maopioid mazamu kana kusangana kwakaipisisa kunomuisa pangozi yakanyanya yekudarika. Vanachiremba vanofanira kudzokorora mashoko ePMMP pavanotanga maopioid therapy nokuda kwekutambudzika kusingaperi uye nguva nenguva munguva yeipioid therapy yehutano husingagumi, kubva pamagetsi ose kusvika kumwedzi mitatu.
10 - Pazvinorondedzera maopioid ekurwadziwa kusingaperi, vanachiremba vanofanira kushandisa kuongororwa kwemishonga mushure vasati vatanga kurapwa kweapioid uye vaone kuongororwa kwemishonga yemuviri gore negore kuti vaongorore mishonga yakatemwa pamwe chete nedzimwe mishonga inorayirwa zvinodhaka uye zvinodhaka zvisina kuwanikwa.
11 - Vanachiremba havafaniri kuchengetedza mishonga yemarwadzo opioid uye benzodiazepines panguva imwe chete kana zvichibvira.
12 - Vanachiremba vanofanira kupa kana kuronga uchapupu-based treatment (kazhinji mishonga-inobatsira kurapwa ne buprenorphine kana methadone pamwe chete nemaitiro ekurapa) kune varwere vane chirwere chekushandisa maopioid.
Zvinotungamirirwa neHurthritis Patients
Mubvunzo: Mitsara yeCDC yekuraira maopioids inoratidzika kutarisa kuti inotanga chirwere cheipioid mune murwere mutsva ane zviratidzo zvinorwadza. Inokurudzira kuedza kurapwa kwete maopioid asati atora opioid?
Dhiyabhorosi Zashin: Mazano anokurudzira kuti maitiro asina uropiyidhi aongorwe asati asarudza opioid yekutambudzika kusingaperi. Zvirwere zvisiri-opioid zvinorwadza zvinosanganisira, asi hazvirevi, kugadziriswa kwehutano hwehutano, kurapwa kwemakorbidities (zvakadai sokuora mwoyo uye kupererwa kweputi), uye dzimwe nzira dzokurapa dzinobatsira kurwadziwa kusanganisira acetaminophen , NSAIDs , tricylic antidepressants, SNRI's (zvakadai se [ Cymbalta] duloxetine ) uye anticonvulsants (zvakadai se [Neurontin] gabapentin). Opioids inokodzera varwere vechirwere kana chirwere chinorwadza chinodikanwa uye chirwere chakakosha chechimwe chimiro cheArthritis kana kuti mamwe maitiro ekurapa kurapa haabatsiri kana kuti anopesana.
Mubvunzo: Mitemo inowedzera kusimbisa zvikwereti uye njodzi yeapioid therapy. Izvi zvinoreva here kuti muongorori wega wega wehutano kune zvibvumirano pamwe nezvengozi chii chinodiwa?
Dhiyabhorosi Zashin: Kutanga nekuenderera mberi kurapwa kwekutambura kwevarwere neopioid kunoda kuongororwa kweumwe munhu uye kuongororazve zvavanoda zve narcotics uye muwandu wemishonga inorwadza inorayirwa.
Miedzo inofanira kuongorora zvikomborero zveepioid therapy, pamwe chete nemigumisiro yemigumisiro inobva kuchirapa. Nhungamiro haitauri huwandu hweopioid chiremba anokwanisa kupa asi inoita zvinotevera zvinorayira maererano nekurapa marwadzo asingagumi angashanda kune varthritis varwere vane kurwadziwa kusingaperi. Nokurwadziwa kusingaperi:
- Shandisa chirwere chakanyanyisa kudarika.
- Nyatsoongorora kana zvikomborero zvinopfuura zvipembenene, kunyanya kana chiyero chakaenzana kana chikuru kune 50 MME (morphine mg kufanana) pazuva (semuenzaniso, 50 mg ye hydrocodone [Norco] pazuva).
- Dzivisa kuwedzerwa chirwere kusvika 90 MME / zuva kana kupfuura.
Uyewo, varwere vanoda kunzwisisa kuti vanachiremba vachada kuvanzwa zvakare muhofisi mukati memwedzi umwe kana kuti nokukurumidza kana vachitanga maopioid ekurwadziwa kusingaperi-uye zvishoma nezvishoma mwedzi mitatu yega yega yevamwe vose vanotora opioid.
Mubvunzo: Ndezvipizve izvo vashandi vanofanira kunzwisisa pamusoro pemitemo itsva?
Dhiyabhorosi Zashin: Urine miedzo yekuongorora zvimwe zvinhu zvinodzorwa zvinogona kurairwa vasati vatapwa uye pakushanyira-kutarisa, sezvo kusanganiswa kwezvinodhaka kune zvimwe zvinhu zvinodzorwa (semuenzaniso, benzodiazepines) zvinogona kuwedzera ngozi yezvinetso, kusanganisira asi kwete kufema nyaya dzinogona kutyisa upenyu.
The Bottom Line
ICDC yakataura kuti murayiridzo unopa mazano kubva pauchapupu hwakanakisisa huripo hwakashandurwa uye hunozivikanwa neanyanzvi maonero. Chirongwa chekliniki yezvesayenzi ichizivisa kukurudzirwa kwakaderera muhutano, zvisinei. Kuzivisa kukurudzirwa kwemazuva ekupedzisira, kutsvakurudza kwakawanda kunokosha kuti uzadze zvikakosha zvinopupurirwa.
Maererano neCDC, "Uchapupu hwekuongorora huri hwaro hwechirevo ichi hunoratidza zvakajeka kuti pane zvakawanda zvingave zvidzidzwa nezvekubudirira, kuchengeteka, uye kugona kwehupfumi kwehutano hwemaawa akawanda kwenguva refu. semusangano inotsigirwa neMasangano eNyika Ezvemishonga pamabasa ekurapa maopioid mukurapa marwadzo asingagumi, "uchapupu hahukwaniki mune zvekupikira kwechirongwa izvo mutapi anoda kuita pamusoro pekushandiswa kweipioid yekutambudzika kusingaperi."
Sezvo huchapupu hutsva huchiwanika, CDC inoronga kudzokera zvakare mutungamiri kuti uone kana zvipupuriro zvipupuri zvakave zvakavharwa zvakakwana kuti zvive nekuvandudzwa kwehutungamiri. Kusvikira kutsvakurudza uku kuchiitwa, kliniki yekuita mirayiridzo inofanira kunge yakavakirwa pauchapupu hwakanakisisa huripo uye nyanzvi maonero.
Izvi zvinotungamirirwa "kunatsiridza kukurukurirana pakati pechiremba nevarwere pamusoro pengozi uye kubatsirika kweapioid therapy nokuda kwekutambudzika kusingaperi, kuvandudza kuchengeteka uye kubudirira kwehutano hwekurwadziwa, uye kuderedza ngozi dzinobatanidza nehutachiona hwehupi hupioid, pamwe nekushandiswa kwemagetsi opioid , kudarika, uye kufa ", maererano neCDC. ICDC yakataurawo kuti "yakagadzirirwa kuongororwa nhungamiro kuti ione zvinogadziriswa pamakiriniki (kureva, chiremba) nemigumisiro yezvirwere, zvose zvakarongwa uye zvisingadi, uye kuongororazve zvinyorwa munguva yekuvandudzwa kwemazuva anotevera kana zvakakodzera."
Icho chinonyanya kukoshesa: Mazano akaiswa mukuvandudza kushandiswa kwakachengeteka kwerapioid uye kuratidza mamiriro ekushandiswa zvisina kunaka. Haisi mhiri kwebasa rekuita kuti kubvisa chirwere che opioid muhutano hwakakodzera hwevarwere.
Kana iwe uchitora maopioid kuti utambudze kusingaperi, tanga hurukuro nachiremba wako pamusoro pezvibatsiro uye njodzi mumamiriro ako ega. Kunyange kana iwe wakanga uine hurukuro iyi munguva yakapfuura, ita zvakare uye uite nguva nenguva. Urombo hausi hutachiona-hunotambudza uye hunogona kuva nani. Kukurukurirana pamusoro peipioid uye pamusoro pemarwadzo ibasa rechiremba uye murwere.
Sources:
CDC Guideline yekutsanangura maOpioids for Chronic Pain - United States, 2016. MMWR. Zvinyorwa uye Zvinyorwa. March 18, 2016. 65 (1); 1-49.
http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm