Kodi regimen yanu ya mankhwala ingakhudzidwe?
Mu March 2016, Centers for Disease Control and Prevention (CDC) inafotokoza malangizo othandizira opioids kuti amve kupweteka kosatha kunja kwa chithandizo cha khansa yogwira ntchito, chisamaliro chosamalidwa, ndi chisamaliro cha kutha kwa moyo. Lipoti la 90+ likhoza kukhala loposa momwe odwala ambiri angathe kapena akufuna kukumba.
Mituyi inali yokwanira kudandaula ambiri odwala matenda aakulu , makamaka omwe adalumphira kumapeto kuti mankhwala omwe amadalira chifukwa cha kupwetekedwa ndi umoyo wa moyo angakhale ovuta, kapena osatheka, kupeza.
Ndaphatikizapo ndondomeko yomwe ili pansipa ndikupempha ndemanga kuchokera kwa katswiri wa mafupa a zinyama Scott J. Zashin, MD kuti athandize odwala nyamakazi kudziwa mmene malangizowa angawakhudzire.
Ma CDC Oyendetsera Opioids for Chronic Pain
Mwachidule, CDC inanena kuti odwala ali ndi ululu ayenera kulandira chithandizo chomwe chimapindulitsa kwambiri pokhudzana ndi zoopsa. Kwa odwala ambiri omwe akudwala nthawi yaitali, CDC inati "Ngakhale opioids ikhoza kuchepetsa ululu panthawi yogwiritsa ntchito kanthawi kochepa, kubwereza umboni wathanzi sikukupeza umboni wodalirika kuti mudziwe ngati chithandizo cha kupweteka chikupitirira ndipo kaya ntchito kapena umoyo wanu umakhala bwino ndi opioid ya nthawi yaitali Ngakhale kupindula kwa kupweteka, kugwira ntchito, ndi khalidwe la moyo ndi ntchito ya opioid ya nthawi yaitali kuti ululu wopweteka ndi wosatsimikizika, zoopsa zogwiritsidwa ntchito ndi opioid nthawi yayitali ndi zomveka. " Tsopano, lolani kukumba mozama.
CDC inagwirizanitsa zokambirana khumi ndi ziwiri muzinthu zitatu zomwe mungakambirane:
Kusankha Nthawi Yoyambitsa kapena Kupitiriza Opioids for Chronic Pain
1 - Opaleshoni ya nonpharmacologic ndi mankhwala osagwiritsa ntchito opioid pharmacologic amakonda kupweteka kosatha. Madokotala ayenera kuganizira za mankhwala opioid pokhapokha ngati akuyembekezerapo kupindula kwa zowawa zonse ndi ntchito zikuyembekeza kupitirira zoopsa kwa wodwalayo. Ngati mankhwala opioids akugwiritsidwa ntchito, ayenera kuphatikizidwa ndi mankhwala osagwiritsidwa ntchito ospharmacologic komanso mankhwala osagwiritsa ntchito opioid pharmacologic, ngati n'koyenera.
2 - Musanayambe mankhwala opioid kuti muvutike kwambiri, madokotala ayenera kukhazikitsa zolinga zamankhwala kwa odwala onse, kuphatikizapo zolinga zenizeni za ululu ndi ntchito, ndipo ayenera kulingalira momwe mankhwala opioid adzathera ngati zopindulitsa sizipitirira zoopsa. Thandizo la opioid liyenera kupitilizidwa kokha ngati pali kusintha kwakukulu m'thupi mwa ululu ndi ntchito zomwe zikuposa zoopsa kuti chitetezo cha odwala chikhalepo.
3 - Musanayambe komanso nthawi zina pa mankhwala opioid, madokotala ayenera kukambirana ndi odwala omwe amadziwika kuti ali ndi mavuto komanso othandizirapo odwala matenda opioid, komanso udindo wodwala komanso wodwala wothandizira kuchipatala.
Kusankhidwa kwa Opioid, Mlingo, Nthawi, Kuwongolera, ndi Kusiyiratu
4 - Poyamba mankhwala opioid kuti amve kupweteka kosalekeza, madokotala ayenera kulamula opioid yomwe imatulutsidwa mwamsanga kusiyana ndi opioids / kutulutsa nthawi yaitali (ER / LA).
5 - Pamene opioids ayamba, madokotala ayenera kupereka mlingo wochepa kwambiri. Madokotala ayenera kuchenjeza polemba opioid pa mlingo uliwonse, ayenera kuwonanso mosamala za ubwino ndi zoopsa za munthu payekha poyesa kuchulukitsa mlingo wa malingana ndi millippine milligram yofanana (MME) / tsiku, ndipo sayenera kuchulukitsa mlingo kuti ≥ 90 MME / tsiku kapena onetsetsani kuti mwasankha kuti mutengere mlingo wa ≥ 90 MME / tsiku.
6 - Ntchito yambiri ya opioid imayamba ndi mankhwala opweteka kwambiri . Ngati opioids amagwiritsidwa ntchito pozunzika kwambiri, madokotala ayenera kupereka chithandizo chochepa kwambiri cha opioid yomwe imatulutsidwa nthawi yomweyo ndipo sayenera kulamula kuti pakhale nthawi yochulukirapo kuposa momwe ikufunira nthawi yaitali ya ululu wambiri umene ungafune opioids. Masiku atatu kapena ocheperako adzakhala okwanira, pamene masiku oposa 7 sadzasowa.
7 - Madokotala ayenera kuyesa zopindulitsa ndi zovulaza (owonongeka, ovulala, kapena zovuta) ndi odwala mkati mwa masabata 1 mpaka 4 akuyambitsa mankhwala opioid kwa ululu wopweteka kapena asanawonjezere mlingo. Madokotala amayenera kufufuza phindu ndi zovulaza za kupitilira chithandizo ndi odwala miyezi itatu iliyonse, ngati kawirikawiri. Ngati zopindulitsa sizipitirira kuipa kwa mankhwala opitirira opioid, madokotala ayenera kuganizira zothandizira zina ndi kugwira ntchito ndi odwala kuti apange opioid ku mlingo wotsika kapena kupiritsa ndi kusiya opioids.
Kuwonetsa Ngozi ndi Kulimbana ndi Ziphuphu Zogwiritsa Ntchito Opioid
8 - Asanayambe ndi nthawi panthawi yopitiliza mankhwala opioid, madokotala amayenera kufufuza zifukwa zoopsa zowononga opioid. Mu dongosolo la mankhwala, madokotala ayenera kukhazikitsa njira zochepetsera chiopsezo, kuphatikizapo kulingalira kupereka yanxone pamene zinthu zomwe zimapangitsa kuti opioid isadwale kwambiri, monga mbiri yowonjezereka, mbiri ya mankhwala osokoneza bongo, miyezo yapamwamba ya opioid (≥50 MME / tsiku), kapena ntchito yogwirizanitsa benzodiazepine, alipo.
9 - Madokotala ayenera kuwerengera mbiri ya wodwalayo ya mankhwala oyenera kugwiritsa ntchito mankhwala pogwiritsa ntchito deta ya PDMP kuti adziwe ngati wodwalayo akulandira mlingo wa opioid kapena kuphatikiza zoopsa zomwe zimamuika pangozi yowonjezereka. Madokotala ayenera kupenda deta ya PDMP poyambitsa mankhwala opioid kuti amve kupweteka kosalekeza nthawi ndi nthawi pa chithandizo cha opioid kwa ululu wopitirira, kuyambira pa mankhwala onse kwa miyezi itatu iliyonse.
10 - Pogwiritsa ntchito opioids kuti amve kupweteka kosalekeza, madokotala ayenera kuyesa kuyezetsa mankhwala a mkodzo musanayambe mankhwala opiira opioid ndikuyesa kuyezetsa mankhwala a mkodzo chaka ndi chaka kuti apeze mankhwala oyenera komanso mankhwala ena oletsa mankhwala ndi mankhwala osokoneza bongo.
11 - Madokotala ayenera kupewa kumwa mankhwala opweteka a opioid ndi benzodiazepines pokhapokha ngati n'kotheka.
12 - Madokotala ayenera kupereka kapena kukonza mankhwala othandizira umboni (kawirikawiri mankhwala othandizira mankhwala ndi buprenorphine kapena methadone kuphatikiza ndi mankhwala ochiritsira) kwa odwala matenda opioid ntchito.
Zomwe Malangizo Akutanthauza Odwala Matenda a Arthritis
Funso: Malemba a CDC olemba ma opioids akuwoneka kuti akuyang'anitsitsa nthawi yoyambitsa mankhwala opioid m'thupi latsopano ndi zizindikiro zowawa. Kodi zimalimbikitsa kuyesa mankhwala osagwiritsa ntchito opioid musanatenge opioids?
Dr. Zashin: Malangizowo amavomereza kuti mankhwala osagwiritsa ntchito opioid ayesedwe asanayambe opioids wa ululu wosatha. Mankhwala osagwiritsidwa ntchito opioid amamva kupweteka, koma samangokhala, chithandizo cha chidziwitso, kusamalidwa bwino (monga kupanikizika ndi kugonana kwa kugona), ndi njira zina zochiritsira zomwe zimathandiza kupweteka kuphatikizapo acetaminophen , NSAIDs , mankhwala osokoneza bongo, SNRI's (monga [ Cymbalta] duloxetine ) ndi anticonvulsants (monga [Neurontin] gabapentin). Opioids ndi oyenerera odwala nyamakazi pamene akufunikira kupweteka kwa kupweteka ndipo njira yeniyeni ya matenda a nyamakazi kapena njira zina zochiritsira zopweteka sizothandiza kapena zimatsutsana.
Funso: Zotsatirazi zimatsindika kuwona ubwino ndi ngozi za mankhwala opioid. Kodi izi zikutanthauza kuti kuunika kwa munthu aliyense payekha phindu ndi zotsatira zake ndizofunikira?
Dr. Zashin: Kuyambitsa ndi kupitiliza chithandizo cha ululu wa odwala ndi opioids kumafuna munthu aliyense kufufuza ndikuwunika momwe akufunira mankhwala osokoneza bongo ndi kuchuluka kwa mankhwala opweteka omwe akuyenera kutero.
Kuyezetsa kuyenera kupenda ubwino wa mankhwala opioid, komanso zotsatira zowopsa za mankhwala. Zotsatirazi sizimangopereka kuchuluka kwa opioid zomwe dokotala angapereke koma zimapanga zotsatirazi motsatira ndondomeko ya ululu wosatha womwe ungagwiritsidwe ntchito kwa odwala nyamakazi omwe ali ndi ululu wosatha. Kuvutika kosatha:
- Gwiritsani ntchito mlingo wotsika kwambiri.
- Onetsetsani kuti phindu lanu liposa zoopsa, makamaka ngati mlingo ndi wofanana kapena woposa 50 MME (homphine mg yogwirizana) tsiku lililonse (mwachitsanzo, 50 mg ya hydrocodone [Norco] patsiku).
- Pewani kuchulukitsa mlingo ku 90 MME / tsiku kapena kuposa.
Komanso, odwala ayenera kumvetsetsa kuti madokotala amafunika kuwabwezeretsanso ku ofesi mkati mwa mwezi umodzi kapena posachedwa atayambitsa ma opioids a ululu wopitirira-miyezi itatu iliyonse kwa odwala onse atenga opioids.
Funso: Ndi chiyani chinanso chomwe odwala ayenera kuchidziwa pa zatsopano?
Dr. Zashin: Kuyesedwa kwa mitsempha kuti ufufuze zinthu zina zowonongeka kungapangidwe musanayambe kuchipatala komanso pakapita maulendo obwereza, monga kuphatikiza kwa mankhwala osokoneza bongo omwe ali ndi zinthu zina zowonongeka (monga benzodiazepines) zingapangitse chiopsezo cha mavuto, kuphatikizapo osaperewera Zinthu zopuma zomwe zingakhale zoopsa.
Mfundo Yofunika Kwambiri
CDC inanena kuti malangizowa amapereka malingaliro okhudzana ndi umboni wabwino womwe ulipo womwe unamasuliridwa ndikuuzidwa ndi akatswiri a maganizo. Umboni wa sayansi wokhudzana ndi chidziwitso chotsimikiziridwa ndi wotsika kwambiri, komabe. Pofuna kulongosola chitukuko cha tsogolo labwino, kufufuza kwina kuli kofunika kudzaza mipata yowonongeka.
Malingana ndi CDC, "Umboni wa umboni womwe umapanga maziko a chitsogozochi ukuwonetseratu bwino kuti pali zambiri zomwe zingaphunzirepo za kuthandizira, chitetezo, ndi kulemera kwa ndalama za mankhwala a opioid. Msonkhanowu udathandizidwa ndi a National Institutes of Health chifukwa cha mankhwala opweteka a opioid pochiza matenda aakulu, "umboni sungakwanitse pa chisankho chilichonse chomwe wothandizira ayenera kuchigwiritsa ntchito pogwiritsa ntchito opioids kuti amve kupweteka kosatha."
Pamene umboni watsopano ukupezeka, CDC ikukonzanso ndondomekoyi kuti adziwe ngati mipata yowonongeka yakhala yotsekedwa mokwanira kuti izi zitheke. Mpaka pano kufufuza uku kuchitika, malangizo azachipatala adzayenera kukhazikitsidwa pa umboni wabwino kwambiri komanso maganizo a akatswiri.
Cholinga ichi ndi cholinga "kupititsa patsogolo kulankhulana pakati pa madokotala ndi odwala za kuopsa ndi phindu la mankhwala a opioid chifukwa cha kupweteka kosalekeza, kupititsa patsogolo chitetezo ndi kupambana kwa mankhwala opweteka, komanso kuchepetsa kuopsa kwa mankhwala a opioid a nthawi yayitali, kuphatikizapo matenda a opioid , overdose, ndi imfa ", malinga ndi CDC. CDC inanenanso kuti "yadzipereka kuti iwonetsetse chitsogozocho kuti adziwe momwe zotsatirazi zikugwiritsidwira ntchito pa chipatala (ie, dokotala) ndi zotsatira za odwala, zonse zomwe zidafunidwa komanso zosayembekezereka, ndikubwezeretsanso malingaliro omwe adzasinthidwe m'tsogolomu."
Mfundo yofunika kwambiri: Malangizowo adayikidwa kuti apititse patsogolo ntchito yogwiritsira ntchito opioid ndikuzindikiritsanso kuti akugwiritsa ntchito mankhwala osayenera. Sizowona kuti ntchito yothetsera opioid ndi yotheka pa odwala oyenera.
Ngati mutenga ululu wa opioids, muyambe kukambirana ndi dokotala wanu za ubwino ndi zoopsa zanu. Ngakhale mutakhala ndi zokambiranazi m'mbuyomo, chitani izi ndikuzichita nthawi ndi nthawi. Zowawa sizomwe zimakhala zolimba-zimakhala zowawa ndipo zimatha kukhala bwino. Kuyankhulana za opioids ndi za ululu ndi udindo wa dokotala komanso wodwalayo.
Zotsatira:
Mndandanda wa CDC Wopereka Opioids for Chronic Pain - United States, 2016. MMWR. Malangizo ndi Malipoti. March 18, 2016. 65 (1); 1-49.
http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm