從止痛劑腎病變看老人的疼痛控制

Analgesic Nephropathy and Pain Management in Older Adults

本文應用兩案例的情境分析，加深讀者對老人錯誤用藥行為的瞭解，及止痛劑腎病變與藥物不良反應和潛在不適當藥物之關聯性。醫療人員應當詳細查明疼痛的原因。根據老人藥物動力學的吸收、分佈、代謝、廓清等分析，老人較年輕人更容易發生藥物副作用及多重藥物交互作用。止痛劑腎病變衝擊突顯了處理老人疼痛的必要性，以及急性、慢性疼痛控制之複雜性。依據疼痛評估結果，為年長者設立一個符合個別化需求的疼痛處置計畫。採取任何疼痛控制的措施之前，檢查腎功能有助於瞭解身體狀況與決定藥物種類、劑量調配。採用藥物治療老人疼痛時，必須謹慎勿超過劑量或藥物交互作用。執行疼痛控制期間，持續再評估病人的臨床表現、疼痛緩解程度、是否發生潛在腎臟毒性，瞭解是否在生理可耐受範圍內獲得合適的止痛效果。本文論述止痛劑腎病變對健康的危害，及介紹老人使用非類固醇消炎藥時的優質措施，鼓勵護理人員發揮照護角色的功能，讓老人使用止痛藥、輔助藥物、補充或另類療法時是安全和有效的。

The two cases discussed in this paper may help readers make sense of unsafe medication behavior in older adults as well as the association between analgesic nephropathy, adverse drug reactions and potentially inappropriate medication. In pain management, the healthcare provider must carefully identifying the cause of pain. Pharmacodynamics analysis of absorption, distribution, metabolism and elimination in the elderly indicated that older adults are more vulnerable to side effects and multiple drug interactions than younger people. The impact of analgesic nephropathy further emphasizes the importance and complexities of acute and chronic pain management in the older population. Pain management in older adults should be based on the outcome of the pain and tailored to each individual patient. Before any measures are taken as part of pain management, a renal function assessment will help clarify the physical condition and with deciding the category and dosage of medication. Pharmacologic treatment of pain in older adults must take care to not deliver overdoses or cause drug interactions. During analgesic management, continuous re-assessment of clinical performance, levels of pain control and potential renal toxicities can help with determining whether the analgesic had yielded an appropriate analgesic effect with acceptable tolerability. This paper describes the risks of analgesic nephropathy and introduces interventions for optimizing NSAIDs prescription practice in older adults. Nursing staff are encouraged to promote the safe and effective usage of analgesic, adjuvant or complementary and alternative medicine in the older adults.