75歳以上の慢性疼痛にNSAIDはダメ?
老衰で看取りの患者さんのペインコントロールが今日の往診で問題になり、気に
なって勉強していたら、アメリカ老年病学会の、75歳以上の慢性疼痛に対するガ
イドラインを見つけました。
http://www.americangeriatrics.org/education/final_recommendations.pdf
気になったのでポイントだけまとめてみました。
1.慢性疼痛への第一選択はアセトアミノフェン
・1日使用量が4gを超えないように注意
2.NSAIDはCOX-2選択的阻害薬含め、選ばれたひと以外には使うべきではない
・胃腸障害、慢性腎不全、心不全あるひとには禁忌
3.中等度以上の痛みを訴える患者はオピオイドの使用が検討されるべきである
…現実的に、保険適応の問題で高齢者全般へのオピオイドの使用は日本では難し
いですけれど。
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