Purpose of Review

Therapeutic use, misuse, abuse, and diversion of controlled substances in managing chronic non-cancer pain remain a major concern for physicians, the government, payers, and patients. The challenge remains finding effective diagnostic tools that can be clinically validated to eliminate or substantially reduce the abuse of controlled prescription drugs, while still assuring the proper treatment of those patients in pain. Urine drug testing still remains an important means of adherence monitoring, but questions arise as to its relevance and effectiveness. This review examines the role of UDT, determines its utility in current clinical practice, and investigates its relevance in current chronic pain management.

Recent Findings

A review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature was searched from year 2000 to present examining the relevance and role of UDT in monitoring chronic opioid therapy along with reliability and accuracy, appropriate use, overuse, misuse, and abuse. There are only a limited number of reviews and investigations on UDT, despite the fact that clinicians who prescribe controlled medications for chronic states commonly are expected to utilize UDT. Therefore, despite highly prevalent use, there is a limited publication base from which to draw in this present study.

Summary

Regardless of experience or training background, physicians and healthcare providers can much more adequately assess opioid therapy with the aid of UDT, which often requires confirmatory testing by a laboratory for clinical and therapeutic prescribing decisions. It has become a strongly recommended aspect of pain care with controlled substances locally, regionally, and nationally. Incorporating UDT for all patients in whom chronic opioid therapy is undertaken is consistent with state and national guidelines and best practice strategies. Practice standards vary as to the frequency of UDT locally, regionally, and nationally, however.

中文翻译：

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慢性疼痛尿液药物检测现状回顾：作为临床工具和抑制滥用仍然有效，还是神秘测试？

审查目的

治疗性使用、误用、滥用和转移受控物质在管理慢性非癌症疼痛中仍然是医生、政府、付款人和患者的主要关注点。挑战仍然是找到有效的诊断工具，这些工具可以通过临床验证来消除或大幅减少受控处方药的滥用，同时仍然确保对这些疼痛患者进行适当的治疗。尿液药物检测仍然是依从性监测的重要手段，但其相关性和有效性出现了问题。本综述检查 UDT 的作用，确定其在当前临床实践中的效用，并调查其在当前慢性疼痛管理中的相关性。

最近的发现

根据系统评价和元分析的首选报告项目 (PRISMA) 声明进行了审查。检索了 2000 年的文献，以检查 UDT 在监测慢性阿片类药物治疗中的相关性和作用，以及可靠性和准确性、适当使用、过度使用、误用和滥用。尽管预期为慢性病开出受控药物的临床医生通常会使用 UDT，但关于 UDT 的审查和调查数量有限。因此，尽管使用非常普遍，但在本研究中可借鉴的出版物基础有限。

概括

无论经验或培训背景如何，医生和医疗保健提供者都可以在 UDT 的帮助下更充分地评估阿片类药物治疗，这通常需要实验室进行确认性测试以做出临床和治疗处方决定。它已成为地方、区域和全国范围内强烈推荐使用受控物质进行疼痛护理的一个方面。对所有接受慢性阿片类药物治疗的患者合并 UDT 符合州和国家指南以及最佳实践策略。然而，当地、地区和国家的 UDT 频率的实践标准各不相同。