老年慢性非癌性疼痛的药物治疗  

Drug Therapy for Chronic Non-Cancer Pain in the Elderly

作　　者：孙雪林[1] 黄厚源 彭旭东 刘德军 张亚同[1] SUN Xue-lin;HUANG Hou-yuan;PENG Xu-dong;LIU De-jun;ZHANG Ya-tong(Department of Pharmacy,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Division of Healthcare,Guard Bureau,Joint Staff Department of the Central Military Commission,Beijing 100017,China)

机构地区：[1]北京医院药学部,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]中央军委联合参谋部警卫局保健处,北京100017

出　　处：《中国合理用药探索》2025年第1期22-26,共5页Chinese Journal of Rational Drug Use

基　　金：中央高水平医院临床科研业务费资助项目(BJ-2023-200);军队保健专项课题(20BJZ47)。

摘　　要：随着我国进入老龄化社会,老年慢性疼痛问题日趋突出。慢性非癌性疼痛主要治疗药物包括非阿片类药物和阿片类药物。考虑老年人对药品不良反应(ADR)的敏感性,非阿片类药物优先于阿片类药物。非阿片类局部镇痛药可避免全身ADR,对乙酰氨基酚是轻度疼痛一线药,但因其具有肝毒性,需确定剂量谨慎使用;抗抑郁药用于神经病理性疼痛,可优选去甲替林;抗癫痫发作药中,普瑞巴林和加巴喷丁较安全;老年人对肌肉松弛药多不耐受。阿片类药物使用需谨慎,对于老年患者要谨慎用药,仅在其他治疗无效且利大于弊时使用,因其可能导致精神状态改变、便秘、平衡能力下降、呼吸抑制等ADR,老年患者剂量应降低并缓慢调整。总之,老年慢性非癌性疼痛治疗需综合考虑多种因素,合理选择药物和治疗方案。As China transitions into an aging society,the prevalence of chronic pain among the elderly is becoming increasingly significant.The primary medications for chronic non-cancer pain include non-opioid and opioid drugs.Considering the sensitivity of elderly to adverse drug reactions(ADR),non-opioid drugs are prioritized over opioid drugs.Non-opioid topical analgesics can mitigate systemic ADR.Acetaminophen is the first-line treatment for mild pain;however,but due to its hepatotoxicity,its dosage must be carefully calibrated and it should be used with caution.Antidepressants are utilized in the management of neuropathic pain.For the elderly,nortriptyline and similar agents are preferable.Among antiepileptic drugs,pregabalin and gabapentin are considered relatively safe.Elderly are often intolerant to muscle relaxants.The use of opioid drugs requires caution,and there are strict principles for elderly patients.They should only be used when other treatments are ineffective and the benefits outweigh the risks,because they may lead to ADR such as changes in mental state,constipation,decreased balance ability,and respiratory depression.The dosage for elderly patients should be reduced and adjusted slowly.In conclusion,the treatment of chronic non-cancer pain in the elderly needs to comprehensively consider multiple factors and make a rational choice of drugs and treatment methods.

关 键 词：慢性非癌性疼痛 老年人 药物治疗 非阿片类药物 阿片类药物 

分 类 号：R969.3[医药卫生—药理学]