老年非癌症慢性疼痛患者之藥控制

Pharmacologic Management of Non-cancer Chronic Pain in the Elderly

老年人經常發生慢性疼痛，並且也受疼痛影響甚多。同時，老化帶來的轉變也使疼痛治療更複雜，並需要更謹慎的考量。對於老年患者的非癌症慢性疼痛，理想的治療計畫必須考慮每位患者的身體狀況、生活能力及社會或家庭的支持，提供個人化的多面向止痛療程。本篇綜論回顧不同藥物治療的療效利益與副作用風險，並討論在老年患者的使用時機與注意事項。在輕度至中度疼痛可優先使用乙醯氨基酚，嚴重疼痛或對第一線治療反應不佳者可在密切監控下使用鴉片類止痛藥。非固醇抗發炎止痛藥由於副作用風險，最好避免長期使用。

Chronic pain is more common and results in more substantial morbidities in the elderly. Meanwhile, the age-related changes in physiology make the pain management more complex and, therefore, may need more attention. The management of non-cancer chronic pain should be personal and multidisciplinary, which is based on the physical status, life function, and social or family support of each patient. This article reviews the efficacy and the risk of adverse effects, timing of the use, and additional considerations of different medications. Acetaminophen is the first-line treatment choice for the elderly with mild to moderate pain. Under closely monitoring, trials of opioids are appropriate for patients with moderate to severe pain or poor responses to the first-line therapies. Considering the significant adverse effects, it is recommended to avoid long-term use of systemic non-steroidal anti-inflammatory drugs.