Given the ubiquitous nature of opioids in the treatment of pain, it is an interesting paradox that this class of medications also represents one of the least understood components of clinical pain medicine. For many years, there has been intense interest in the mechanisms of opioid activity, but this has not resulted in a corresponding increase in convincing clinical data. This review focuses primarily on the evidence surrounding the long-term use of opioids in chronic pain, but discussions of this research are often conflated with the very different data governing acute and cancer-related pain, where evidence of efficacy is clearer. It is therefore important to clarify the evidence-based indications for opioid therapy. There remains very little evidence that opioids improve function or quality of life beyond 3 months in people with chronic pain conditions. In all three patient populations, the development of tolerance, dependence, hyperalgesia and withdrawal are key phenomena that affect the patient experience, and in particular the decision to remain on opioids in the long term. This is a common thread that connects the opioid literature in all of these spheres, and justifies the burgeoning interest in these phenomena in the basic science literature. There is an urgent need to address these negative consequences of opioid use, in order to maximize the therapeutic benefit that opioids can offer.

中文翻译：

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成人阿片类药物的疼痛管理

鉴于阿片类药物在疼痛治疗中无处不在，有趣的悖论是，这类药物也代表了临床疼痛医学中最不为人知的成分之一。多年来，人们一直对阿片类药物的活性机制产生浓厚的兴趣，但这并没有导致令人信服的临床数据相应增加。这篇综述主要关注关于长期使用阿片类药物治疗慢性疼痛的证据，但对这项研究的讨论通常与管理急性和癌症相关疼痛的非常不同的数据混为一谈，其中的疗效证据更加清晰。因此，阐明阿片类药物治疗的循证适应症非常重要。几乎没有证据表明阿片类药物可改善慢性疼痛患者 3 个月后的功能或生活质量。在所有三个患者群体中，耐受性、依赖性、痛觉过敏和戒断的发展是影响患者体验的关键现象，尤其是长期使用阿片类药物的决定。这是将所有这些领域的阿片类药物文献联系起来的共同线索，并证明了基础科学文献中对这些现象的迅速兴趣是正当的。迫切需要解决阿片类药物使用的这些负面后果，以最大限度地提高阿片类药物可以提供的治疗益处。尤其是长期使用阿片类药物的决定。这是将所有这些领域的阿片类药物文献联系起来的共同线索，并证明了基础科学文献中对这些现象的迅速兴趣是正当的。迫切需要解决阿片类药物使用的这些负面后果，以最大限度地提高阿片类药物可以提供的治疗益处。尤其是长期使用阿片类药物的决定。这是将所有这些领域的阿片类药物文献联系起来的共同线索，并证明了基础科学文献中对这些现象的迅速兴趣是正当的。迫切需要解决阿片类药物使用的这些负面后果，以最大限度地提高阿片类药物可以提供的治疗益处。