Ngaba i-regimen yonyango iya kuthinteka?
Ngo-Matshi 2016, amaziko okuLawula nokuVimbela (i-CDC) apapashile izikhokelo zokumisela i-opioids yeentlungu ezingapheliyo ngaphandle kwonyango olushukumisayo lomhlaza, ukunakekelwa kwinkathalo kunye nokunyamekela kwexesha lokuphila. Ingxelo yekhasi le-90 + ingaba ngaphezu kwezona ezininzi izigulane zinokuthi zifune okanye zifune ukugaya.
Ezi zihloko zanele ukukhathazeka ezininzi izigulane zintlungu ezingapheliyo , nangakumbi abo bazama ukufikelela kwisigqibo sokuba unyango oluxhomekeke kwiintlungu zoxolo kunye nemigangatho yobomi kuya kuba nzima, ukuba akunakwenzeka, ukufumana.
Ndiyishwankathele iingcebiso ezingezantsi kwaye ndicele amazwana avela kwi- rheumatologist uScott J. Zashin, MD ukuba ancede izigulane ze- arthritis ziqonde ukuba izikhokelo zingabathinta njani.
Izikhokelo ze-CDC zokuLawulwa kwama-Opioids for Pain Chronic
Ngamafutshane, i-CDC yathi izigulane ezinentlungu kufuneka zithole unyango olubonelela ngenzuzo enkulu kunxulumene nobungozi. I-CDC yathi i-CDC ithi "Nangona i-opioids inokunciphisa intlungu ngexesha lokusetyenziswa kwexesha elifutshane, ubungqina bobugqirha bobuchopho bufumana ubungqina obunelungelo lokuqinisekisa ukuba intlungu inokugcinwa kwaye ingaba umsebenzi okanye umgangatho wobomi uphucula ngexesha elide le-opioid Nangona iimeko zokuphucula iintlungu, umsebenzi kunye nomgangatho wobomi kunye nokusetyenziswa kwexesha elide lwe-opioid yeentlungu ezingapheliyo, azinokuqinisekiswa, izingozi ezinxulumene nokusetyenziswa kwe-opioid ende ixesha elide zicacile kwaye zibalulekileyo. " Ngoku, vumela ukucima.
I-CDC iqokelele iingcebiso ezi-12 kwiindawo ezintathu zokuqwalasela:
Ukuqaphela ixesha lokuqalisa okanye ukuqhubela phambili i-Opioids ye-Pain Pain
1 - Unyango lwe-Nonpharmacologic kunye neyeza elingenalo i-opioid unyango lwe-pharmacologic lukhethwa ukuba lubuhlungu obungapheliyo. Oogqirha kufuneka baqwalasele unyango lwe-opioid kuphela xa kunenzuzo ekulindelekileyo yentlungu kunye nomsebenzi kulindeleke ukuba ikhulise ingozi kwisigulane. Ukuba i-opioids isetyenziswe, kufuneka idibaniswe ne-nonpharmacologicalic therapy kunye neyeza ezingekho nge-opioid ye-pharmacologic, njengoko kufanelekile.
2 - Ngaphambi kokuba uqalise unyango lwe-opioid ngenxa yobuhlungu obungapheliyo, oogqirha kufuneka bazise iinjongo zonyango kuzo zonke izigulane, kubandakanywa iinjongo ezibonakalayo zentlungu kunye nomsebenzi, kwaye kufuneka sicinge ukuba unyango lwe-opioid luya kupheliswa njani xa iinzuzo zingabi ngaphezu kweengozi. Ulwaphulo lwe-opioid lufanele luqhutyelwe kuphela ukuba kukho ukuphuculwa koluphiko kwintlungu kunye nomsebenzi ogqithisa ingozi ekukhuseleni isigulane.
3 - Ngaphambi kokuqala kunye nexesha ngexesha lophilo lwe-opioid, oogqirha kufuneka baxoxe ngezigulane eziziwayo kunye neenzuzo ezibonakalayo zonyango lwe-opioid, kwakunye nexanduva lomgulane kunye neekliniki zokulawula unyango.
Ukhetho lweOpioid, Isisombululo, ixesha, ukulandelwa kunye nokuCima
4 - Xa uqala unyango lwe-opioid ngenxa yobuhlungu obungapheliyo, oogqirha kufuneka banikeze i-opioid yokukhululwa ngokukhawuleza kunokuba kukhululwe-ixesha elide / i-opioids.
5 - Xa i-opioids iqalile, oogqirha kufuneka banikeze umlinganiselo ophantsi kakhulu. Oogqirha kufuneka baqaphele xa beka i-opioid nayiphi na i-dosage, kufuneka baphinde baqikelele ubungqina bemivuzo kunye neengozi xa bejonga ukunyuka kwama-≥50 e-morphine equals equals (MME) / ngosuku, kwaye kufuneka bakuphephe ukwandisa umlinganiselo kwi-90 MME / ngosuku okanye ukulungelelanisa ngenyameko isigqibo sokubamba isantya kwi-≥90 MME / ngosuku.
6 - Ukusetyenziswa kwexesha elide i-opioid kudla ngokuqala ngokunyanga kwentlungu . Xa i-opioids isetyenziselwa ubuhlungu obukhulu, oogqirha kufuneka banikeze umthamo ophantsi kakhulu we-opioid kunye nokunyanzela ukukhupha i-opioid kwaye kufuneka ibeke umlinganiselo omkhulu kunokuba kudingeke ukuba ubude bexesha elilindelekileyo lweentlungu ezinzima zokufuna i-opioids. Iintsuku ezintathu okanye ngaphantsi ziya kuthi zanele ngokwaneleyo, ngelixa iintsuku ezingaphezulu kwe-7 ziza kufuneki.
7 - Oogqirha kufuneka bavavanye iingeniso kunye nezibi (imonakalo, ukulimala, okanye iziganeko ezimbi) kunye nezigulana kwisithuba se-1 ukuya kwiiveki ezi-4 zokuqala unyango lwe-opioid ngenxa yobuhlungu obungapheliyo okanye ngaphambi kokwandisa umthamo. Oogqirha kufuneka bavavanye iingenelo kunye neziphumo ezinonyango zokuqhubeka unyango kunye nezigulane rhoqo kwiinyanga ezi-3, ukuba azikho rhoqo. Ukuba iingeniso azigqithisi izixhobo eziqhubekayo zokwelapha i-opioid, oogqirha kufuneka bagxininise kwezinye iindlela zokwelapha kwaye basebenze nezigulane zokufaka i-opioids kwisilinganisi esisezantsi okanye ukucoca kunye nokuyeka i-opioids.
Ukuphonononga ingozi kunye nokujongana neHarms ye-Opioid Usetyenziso
8 - Ngaphambi kokuqala kunye nexesha ngexesha lokuqhubela phambili unyango lwe-opioid, oogqirha kufuneka bavavanye umngcipheko weemeko ezinxulumene ne-opioid. Kwiplani yokwenza unyango, oogqirha kufuneka babe neendlela zokunciphisa umngcipheko, kubandakanywa nokucwangcisa i-naloxone xa kukho izinto ezinomngcipheko wokugqithisa i-opioid, njengembali yokugqithisa ngokwexesha, imbali yokusetyenziswa kwezidakamizwa, ii-opioid ephezulu (i-50 MME / imini), okanye ukusetyenziswa kwe-benzodiazepine efanayo, zikhoyo.
9 - Oogqirha kufuneka bahlaziye imbali yesigulane kwimigqaliselo yezinto ezilawulwayo usebenzisa i-state prescription drug surveillance program (PDMP) idatha ukuqinisekisa ukuba isigulane sithola iifayili ze-opioid okanye inhlanganisela eyingozi ebeka emngciphekweni omkhulu wokugqithisa. Oogqirha kufuneka bahlolisise iinkcukacha ze-PDMP xa beqala unyango lwe-opioid ngenxa yobuhlungu obungapheliyo kwaye ngezihlandlo ngexesha lonyango lwe-opioid ngenxa yobuhlungu obungapheliyo, ukusuka kuyo yonke imithi nganye kwiinyanga ezintathu.
10 - Xa ugunyazisa i-opioids yeentlungu ezingapheliyo, oogqirha kufuneka basebenzise ukuhlolwa kweziyobisi zomchamo ngaphambi kokuba baqale unyango lwe-opioid kwaye baqwalasele ukuvavanywa kweziyobisi emanzini rhoqo ngonyaka ukuvavanya imithi enqunyiwe kunye nezinye iziyobisi ezilawulwayo kunye neziyobisi ezingekho mthethweni.
11 - Oogqirha kufuneka bakuphephe ukumisela imithi yeentlungu ze-opioid kunye ne-benzodiazepines ngokukhawuleza xa kunokwenzeka.
12 - Oogqirha kufuneka banikeze okanye bahlele unyango olusisekelwe kubungqina (ngokuqhelekileyo unyango oluxhaswa ngamachiza kunye ne-buprenorphine okanye i-methadone enxulumene neendlela zokuziphatha) kwizigulane ezine-opioid disorder disorder.
Ziziphi izikhokelo ezibhekiselele kwizigulane zeArthritis
Umbuzo: Izikhokelo ze-CDC zokumisela i-opioids zibonakala zijolise ekuqaliseni unyango lwe-opioid kwisigulane esitsha ngeempawu zentlungu. Ingaba iyincoma ukuzama unyango olungekho opioid ngaphambi kokuthatha i-opioids?
UDkt. Zashin: Izikhokelo zincoma ukuba unyango olungekho opioid luya kuhlolwa ngaphambi kokumisela i-opioids yeentlungu ezingapheliyo. Ulwaphulo lwe-opioid olungenayo i-opioid yentlungu lubandakanya, kodwa alukhawulelwanga, unyango lweendlela zokuziphatha, unyango lwe- comorbidities (njengokudandatheka kunye ne-apnea yokulala), kunye nonyango oluthile olunceda ngeentlungu ezibandakanya i- acetaminophen , i- NSAID , i-anti-depressants tricylic (njenge- [ Cymbalta] duloxetine ) kunye ne-anticonbulsants (ezifana ne-Neurontin] gabapentin). I-opioids ifanelekile kwizigulane ze-arthritis xa kufuneka ukulawulwa kwintlungu kwaye unyango oluqhelekileyo uhlobo oluthile lwe-arthritis okanye olunye unyango lwezonyango oluncedo aluncedo okanye aluchaswanga.
Umbuzo: Izikhokelo zigxininisa ubunzima beengxaki kunye neengozi zonyango lwe-opioid. Ngaba oku kuthetha ukuba ukuhlolwa kwesigulane ngamnye kwiintlawulo ngokubhekiselele engozini yintoni eyimfuneko?
UDkt Zashin: Ukuqaliswa kunye nokuqhubeka unyango lweentlungu zesigulane kunye ne-opioids kufuna ukuhlolwa komntu ngamnye kunye nokuhlolwa kwakhona kweemfuno zabo zeengxaki zonyango kunye nenani lezonyango ezimiselweyo.
Iimvavanyo kufuneka zihlolisise izibonelelo zonyango lwe-opioid, kunye nemiphumo emibi yonyango. Izikhokelo azithinteli inani le-opioids ugqirha unokumisela kodwa lenza iziphakamiso ezilandelayo ngokunyanga kwentlungu engapheliyo eya kusebenza kwizigulane ze-arthritis ezineentlungu ezingapheliyo. Ukubuhlungu okungapheliyo:
- Sebenzisa iqondo eliphantsi kakhulu.
- Qaphela ngokucophelela ukuba iinjongo zigqithise kakhulu ingozi, ingakumbi ukuba idosi lilingana okanye likhulu ukuya kuma-50 MME (i-morphine mg equals) ngosuku (umzekelo, 50 mg ye- hydrocodone [Norco] ngosuku).
- Gwema ukwandisa umthamo ukuya kwi-90 MME / okanye ngaphezulu.
Kwakhona, izigulana zifuna ukuqonda ukuba oogqirha baya kufuna ukuba babuye eofisini kwinyanga enye okanye ngokukhawuleza xa beqala i-opioids yokuvalelwa kabuhlungu-kwaye ubuncinane kwiinyanga ezi-3 kuzo zonke izigulana ezithatha i-opioids.
Umbuzo: Yintoni enye kufuneka izigulane ziqonde malunga nezikhokelo ezintsha?
UDkt. Zashin: Uvavanyo lwee- urine ukujonga ezinye izinto ezilawulwayo zingahle zenziwe ngaphambi kokuba unyango kunye nokuhanjelwa okulandelelweyo, njengoko ukudibanisa neengqungquthela kunye nezinye izinto ezilawulwayo (umzekelo, i-benzodiazepines) kunokunyusa umngcipheko weengxaki, kubandakanywa kodwa ezingaphelelanga Imiba yokuphefumula engasongela ubomi.
Ngaphantsi
I-CDC ibonise ukuba isikhokelo sinikeza iingcebiso esekelwe kubungqina obuninzi obufumanekayo obuchazwe kwaye lukwaziswa ngoluvo lwengcali. Ubungqina bezenzululwazi eziseklinikhi ezikwazisa iingcebiso ziphantsi kobukhulu, nangona kunjalo. Ukuzisa ukuphuhliswa kwexesha elizayo, kukho uphando olongezelelweyo ukuzalisa ubungqina obubalulekileyo.
Ngokutsho kweCDC, "Ubungqina bobuchule obwenza isiseko sale khokelo lubonisa ngokucacileyo ukuba kukho into eninzi ingafundwa ngokusebenza, ukhuseleko kunye nokusebenza kakuhle koqoqosho lwe-opioid yexesha elide. iindibano ezixhaswe yiZiko leZiko lezeMpilo ngenxaxheba yonyango lwamafutha opioid ekunyangekeni kobuhlungu obungapheliyo, "ubungqina abukwaneli kuzo zonke izigqibo zonyango ukuba umniki-mveliso kufuneka akwenze malunga nokusetyenziswa kwe-opioids yeentlungu ezingapheliyo."
Njengoko ubungqina obutsha buba khona, i-CDC iceba ukuphinda ibuyele isikhokelo sokuqaphela ukuba ubungqina beempazamo sele zivaliwe ngokwaneleyo ukuba ziqinisekise ukuhlaziywa kwesi khokelo. Kuze kube lucwaningo luqhutyelwe, izikhokelo zenkcubeko ziza kusekelwe kubungqina obuninzi obukhoyo kunye neengcamango zengcali.
Esi sikhokelo senzelwe ukuba "ukuphucula unxibelelwano phakathi koogqirha kunye nezigulane malunga neengozi kunye neenzuzo zonyango lwe-opioid ngenxa yobuhlungu obungapheliyo, ukuphucula ukhuseleko kunye nokuphumelela kwonyango lwentlungu, nokunciphisa ingozi echaphazelekayo nonyango lwe-opioid elide, kuquka ukusetyenziswa kwe-opioid , ukudlula ngaphezulu, nokufa, "ngokwe-CDC. I-CDC yathi kwakhona "inzibophelelo ekuhloliseni isikhokelo ekuboneni impembelelo yeengcebiso kwiinkliniki (oko kukuthi, ugqirha) neziphumo zezigulane, zombini zijoliswe kwaye zingalindelekanga, kwaye ziphinde ziphinde zibuyele iingcebiso kwiimbuyekezo ezizayo xa ziqinisekisiwe."
Umgca wokugqibela: Izikhokelo zenziwe ukuphucula ukusetyenziswa ngokukhuselekileyo kwonyango lwe-opioid kwaye ukuchonga amatyala okusetyenziswa kakubi. Akusiyo yonke imigudu yebhodi yokuphelisa unyango lwe-opioid kwindawo efanelekileyo yezigulane.
Ukuba uthatha i-opioids ngentlungu engapheliyo, qalisa ingxoxo nodokotela wakho malunga neenzuzo kunye nobungozi kwimeko yakho. Nangona ufumane le ngxoxo kwixesha elidlulileyo, yenza kwakhona kwaye wenze njalo. Ubunzima abuyiyo into eqinileyo-ibuhlungu kwaye ingaba ngcono. Unxibelelwano malunga ne-opioids kunye nentlungu kukuba uxanduva loogqirha kunye nesigulane.
Imithombo:
I-CDC Isikhokelo sokuBhala iiOpioids for Pain Pain - United States, 2016. MMWR. Iingcebiso kunye neengxelo. Matshi 18, 2016. 65 (1); 1-49.
http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm