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Risikofaktoren für Missbrauch und Abhängigkeit bei der Opioidtherapie chronischer nicht-tumorbedingter Schmerzen

Risk factors for substance abuse and dependence in opioid therapy for chronic noncancer-related pain

  • Schwerpunkt: Opioide
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Zusammenfassung

Opioide sind wertvolle Analgetika, die nicht nur bei tumorbedingten, sondern auch chronischen nicht-tumorbedingten Schmerzen zu Schmerzlinderung und funktioneller Verbesserung führen können. Aktuelle Daten zeigen jedoch, dass die zunehmende Verschreibung von Opioiden mit ansteigenden Zahlen missbräuchlichen Verhaltens verbunden ist. Dessen Ursache ist multifaktoriell. Pharmakotherapeutische Faktoren sind bekannt.

Besonderes Gewicht aber haben psychosoziale und ätiologische Risikofaktoren. Zunehmend spielen iatrogene Faktoren eine Rolle, so mangelndes Wissen über psychische Einflussfaktoren auf Schmerzen und fehlende Bereitschaft zur interdisziplinären Therapie. Liegen Risikofaktoren vor, ist die Indikation zur Opioidgabe nur nach interdisziplinärer Diagnostik im Konsens zu stellen. Die Integration in eine multimodale interdisziplinäre Therapie ist nötig, das Abfassen eines Behandlungsvertrages ist ratsam.

Zur Therapiekontrolle gehören analgetische Wirksamkeit, Nebenwirkungskontrolle, funktioneller Zustand und missbräuchliches Verhalten, gegebenenfalls einschließlich gelegentlicher Urinkontrollen. Bei mangelndem Therapieerfolg muss die Therapie beendet werden, andernfalls sind iatrogene Schädigung, Missbrauch und illegale Weitergabe des erfolglos verabreichten Opioids an Dritte möglich.

Abstract

Opioids are valuable analgesics, capable of providing pain relief and functional improvement not only in patients with cancer-related pain, but also in chronic noncancer-related pain patients. However, recent data have shown that the increasing prescription of opioids is associated with a rise in aberrant drug-related behaviour. The causes of this behaviour are multifactorial.

Some pharmacotherapeutic, but in particular psychosocial risk and etiologic pain factors have been identified. The indication for the prescription of opioids must be very carefully weighed in the presence of any risk factors. In these cases the integration into a multimodal, interdisciplinary therapy programme is mandatory. A contractual agreement on the opioid therapy including goals, side effects, controls including urine drug testing and criteria to finish the opioid therapy are advisable.

Assessment of the progress of therapy is based on the following factors: analgesic efficacy, adverse side effects, functional status and aberrant drug-related behaviour. In the absence of a successful opioid therapy, the treatment must be discontinued to avoid iatrogenic damage, substance abuse and illegal diversion. After discontinuation of the therapy, a comprehensive interdisciplinary re-evaluation is required.

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Danksagung

Die Autoren bedanken sich bei Herrn Prof. Dr. T.U. Egle und Herrn PD R. Nickel aus der Klinik für Psychosomatische Medizin und Psychotherapie am Klinikum der Johannes-Gutenberg-Universität Mainz für wertvolle Hinweise.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Klinikum der Johannes-Gutenberg-Universität, Mainz

    J. Jage

  2. Universitätsklinik für Anaesthesiologie, Intensiv- und Schmerztherapie, Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum

    A. Willweber-Strumpf

  3. Abteilung für Schmerztherapie, Universitätsklinik für Anaesthesiologie, Intensiv- und Schmerztherapie, Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum

    C. Maier

  4. Klinik für Anästhesiologie, Klinikum der Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55131, Mainz

    J. Jage

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  1. J. Jage
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  3. C. Maier
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Jage, J., Willweber-Strumpf, A. & Maier, C. Risikofaktoren für Missbrauch und Abhängigkeit bei der Opioidtherapie chronischer nicht-tumorbedingter Schmerzen. Schmerz 19, 434–440 (2005). https://doi.org/10.1007/s00482-005-0426-7

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