What You Should Know About Opioids and Painkillers | Body Stuff with Dr. Jen Gunter | TED

Opioids are one of the most commonly prescribed painkillers.

譯者: Winston Chung 審譯者: Yi-Ping Cho (Marssi)

類鴉片藥物是 最常見的處方止痛藥之一。

From broken ribs to back pain to treating pain after surgery.

用途包括肋骨斷裂， 背痛或手術後止痛。

But there's a lot of misconceptions around them,

但是對這藥物人們有很多誤解，

so it's important to take the time to understand them better.

所以花點時間好好了解它們 是很重要的。

[Body Stuff with Dr. Jen Gunter]

【珍·甘特醫生談身體的五四三】

The first misconception is that opioids are the best,

第一個誤解是類鴉片藥物是最好、

strongest form of pain medication.

最強的止痛藥。

But in almost every well-designed study

但是，幾乎每個設計得當、

comparing opioids to anti-inflammatory drugs such as ibuprofen,

比較類鴉片藥物和像布洛芬之類的 消炎藥的研究，

the anti-inflammatories come out on top.

都發現消炎藥比較好。

From a safety or effectiveness perspective, or both.

不論是以安全或效用來看， 或兩者同時評估。

Let's talk about the effectiveness first.

先談效用。

How do opioids work?

類鴉片藥物怎麼作用的？

To understand that, we have to first know a little bit about how pain works.

要了解這個，我們得先 明白疼痛怎麼作用。

Pain is our body's way of telling us that something's wrong.

疼痛是我們身體告訴我們 哪裡不對勁的辦法。

You stubbed your toe, you burned your hand.

你踢到腳趾頭，或燙到手。

Pain gives us the message that it's time for us to rest,

疼痛給我們訊息， 告訴我們應該立刻休息，

recover and treat the damage.

恢復，且治療傷害。

In the body, pain is created by multiple chemical signals and receptors,

在身體裡，疼痛是由幾個 化學訊號和受體製造出來的，

and different medications can target different parts of that pain pathway.

而不同的藥物可針對 疼痛途徑的不同部分來止痛。

Medications like acetaminophen, such as Tylenol,

乙醯胺酚類藥物，像泰諾，

or nonsteroidal anti-inflammatory drugs,

或非類固醇消炎藥，又稱 NSAID，

also known as NSAIDs, like ibuprofen, aspirin and naproxen,

像布洛芬、阿斯匹靈、萘普生，

all treat pain in different ways from opioids.

都和類鴉片藥物處理疼痛的方法不同。

Opioids work by binding to and activating the opioid receptors

類鴉片藥物靠連結並啟動

分布全身的鴉片受體， 進而阻斷疼痛訊號。

located throughout the body, blocking pain signals.

This activation also triggers the release of dopamine,

這受體啟動也釋放多巴胺，

a hormone associated with pleasure.

這是一種和快感有關的荷爾蒙。

So in addition to pain relief,

所以除了止痛，

some people can feel relaxed or even euphoric.

有些人會覺得放鬆，甚至亢奮。

In higher doses, opioids can affect cognition and even breathing.

高劑量的類鴉片藥物 可能會影響認知，甚至呼吸。

But here's a really important point that people often don't know.

但是這裡有很重要的一點， 大家卻往往不知道。

Opioid receptors can adapt, often in a short amount of time,

鴉片受體常在很短的時間內， 就適應而期待類鴉片藥物。

to expect opioids.

And when a patient doesn’t take them,

當病人不再用藥，

they experience symptoms of withdrawal.

就會經歷藥物戒斷的症狀。

And withdrawal is very uncomfortable.

藥物戒斷是非常不舒服的。

People can mistake that discomfort

人們可能把這種不舒服誤認為

for thinking the opioids were actually working.

類鴉片藥物有效用。

And what people don't know is this can happen after just a few doses.

而且大家不知道 只要服用幾次就可能發生。

When you're a patient needing relief from pain,

當你是個需要止痛的病人，

it can be confusing to know the difference.

可能無法明白其中的差別。

All you want is to feel normal again.

你只想要覺得回歸正常。

In this way, opioids, if not used very carefully and intentionally,

如果沒有小心有意識地 使用類鴉片藥物，

can create physical dependence.

就可能會造成身體對藥物的依賴。

They can also paradoxically worsen pain.

這種藥物也可能矛盾地使疼痛更嚴重，

And there's a risk of developing addiction.

而且還造成上癮的危險。

There's nuance here.

這裏有一個需要注意的細節。

People who have become physically dependent

人在身體上依賴藥物，

often don't even know they are.

常常還不知道自己已經如此。

They just know that the opioids seem to be offering relief

他們只知道類鴉片藥物好像幫助緩解，

without realizing that they could actually be contributing to the pain.

而不知道事實上也可能增長疼痛。

I want to be clear here.

我要說清楚：

Opioids can be effective, appropriate therapy,

服用類鴉片藥物 可以是有效而適當的療法，

but they should be prescribed with great care.

但是開這種處方要很小心。

This is the doctor's responsibility.

這是醫生的責任。

Here's some advice so you can be an educated patient.

這裡有幾個建議 讓你當個精明的病人。

If you or a loved one experience acute pain,

如果你或你愛的人有極度疼痛，

ask to explore alternatives to opioids like Tylenol,

要求嘗試類鴉片藥物之外的方法，

像泰諾，非類固醇消炎藥， 肌肉鬆弛劑，或物理治療。

NSAIDs, muscle relaxants and physical therapy.

If your doctor doesn’t bring those up first,

如果你的醫生沒有先提起那些，

and if you or a loved one are prescribed opioids,

而你們得到類鴉片藥物處方，

make sure your doctor has a plan to taper you off,

要確保醫生有減少用藥的計畫，

accounting for the risk of dependence.

以免有藥物依賴的風險。

And finally, ask for naloxone.

最後，要求納洛酮。

This is a drug that can reverse opioid overdose.

這是個可以逆轉鴉片藥物過量的藥。

It can be easy to forget if you’ve taken a dose,

你可能會忘記你有沒有吃過藥，

and you never know who in your household could take your medication.

而且你也不會知道家裡誰可能吃你的藥。

Naloxone can literally save a life.

納洛酮真的能救回一條命。

Remember, when it comes to pain,

記得，講到疼痛，

opioids are not always the most effective way to safely offer relief.

類鴉片藥物不一定是 最有效安全緩解的方法。

And when they are prescribed,

而且開這個處方時，

they should always be prescribed with a plan.

一定要有個計畫跟隨著處方。