慢性神经病理性疼痛治疗方式的改变：阿片类药物的耐受机制、停药策略与多模式非阿片替代疗法

Paradigm Shift in Chronic Neuropathic Pain Treatment: Opioid Tolerance Mechanisms, Discontinuation Strategies, and Multimodal Non-Opioid Alternatives

关键词:  慢性疼痛  神经病理性疼痛  阿片类药物  耐受  痛觉过敏  停药  多模式镇痛  非阿片类药物

Key words:  chronic pain  neuropathic pain  opioids  tolerance  hyperalgesia  drug discontinuation  multimodal analgesia  non-opioid drug

摘要:

当前慢性非癌性疼痛（chronic non-cancer pain, CNCP），特别是慢性神经病理性疼痛的临床管理正处于观念重构的关键时期。长期以来，受癌症疼痛管理阶梯疗法的影响，强阿片类药物（如羟考酮、吗啡）被广泛应用于慢性神经痛的维持治疗。本综述旨在说明在慢性神经病理性疼痛中，应严格限制长期维持使用强阿片类药物，将药品定位为仅用于爆发性疼痛的低频、紧急救援手段，并最终通过非阿片类药物的混合及替代疗法实现去处方化。

Abstract:

The clinical management of chronic non-cancer pain (CNCP), particularly chronic neuropathic pain, is currently undergoing a critical paradigm shift. Historically, influenced by the WHO analgesic ladder for cancer pain, potent opioids (e.g., oxycodone, morphine) have been extensively utilized as maintenance therapy for chronic neuropathic pain. This review aims to emphasize that the long-term maintenance use of strong opioids for chronic neuropathic pain should be strictly restricted. These medications must be repositioned exclusively as infrequent, emergency rescue interventions for breakthrough pain. Ultimately, the goal is to facilitate deprescribing through multimodal non-opioid and alternative therapies.