만성 비암성통증에서 마약성 진통제의 사용

Abstract

The use of opioids for chronic noncancer pain has increased in recent years, although evidence for its long-term effectiveness is weak and its potential for harm is significant. Most reports suggest that chronic opioid therapy can be effective for the reduction of chronic pain and for the improvement of functioning and health-related quality of life. However, opioids are also associated with potentially serious harm including pharmacologic adverse effects and socioeconomic problems such as abuse, addiction, and diversion. Physicians should use a structured approach that includes a biopsychosocial evaluation and treatment plan that encourages patients to reach functional goals. There should be a comprehensive evaluation of the cause of pain, assessment for risk of opioid complications (including misuse and addiction), and a detailed treatment history including a review of medical records. Regular monitoring for safety and effectiveness is essential including regular checking of functional improvement and progress towards the pretreatment goals. Ineffective or unsafe opioid therapy should be promptly tapered or stopped. In Korea until now, there are no adequate recommendations for opioid prescription in the management of chronic noncancer pain. A Korean guideline or task force team should be established to provide personalized treatment for carefully selected and monitored patients.