瘙痒症（也被称为瘙痒）定义为一种令人不悦和刺激的皮肤感觉，引发刮抓或搓揉的欲望。已知阿片类药物可引起瘙痒，这是矛盾的，因为瘙痒和疼痛在感觉通路上有重叠。由于阿片类药物抑制疼痛但可引起瘙痒，对阿片诱导的瘙痒的机制还有许多未知之处。阿片类诱导的瘙痒的预防和治疗仍然是疼痛管理领域的挑战。本综述的目的是介绍和讨论目前文献资料，综述阿片诱导的瘙痒机制及其与止痛作用的关系，并提供可能的治疗选择。不同阿片类药物和给药途径导致的阿片诱导的瘙痒发生率有所不同，其机制可大致分为外周和中枢。尤其是中枢机制相当复杂，甚至在脊髓背角水平也是如此。有证据表明，阿片受体拮抗剂和混合激动剂和拮抗剂，特别是μ阿片受体拮抗剂和κ阿片受体激动剂，在缓解阿片诱导的瘙痒方面是有效的。已经应用了多种治疗方法治疗阿片诱导的瘙痒，但大部分存在争议且结果相互矛盾。采用多模式镇痛治疗方案结合混合受体拮抗剂和κ激动剂，特别是μ阿片受体拮抗剂和κ阿片受体激动剂，似乎是目前处理阿片诱导的瘙痒和疼痛的最佳方式。阿片类药物仍然是中等到严重急性疼痛以及癌症疼痛的治疗的黄金标准。众所周知，阿片诱导的瘙痒通常不对常规止痒治疗有反应，给疼痛管理领域的临床医生带来了挑战。我们认为我们的综述对文献具有重要贡献，因为关于阿片诱导的瘙痒机制和有效的管理策略的研究对于这些患者的处理至关重要。© 2023 The Authors. 由John Wiley & Sons Ltd代表European Pain Federation - EFIC®发表的European Journal of Pain.

Pruritus (also known as itch) is defined as an unpleasant and irritating sensation of the skin that provokes an urge to scratch or rub. It is well known that opioid administration can cause pruritus, which is paradoxical as itch and pain share overlapping sensory pathways. Because opioids inhibit pain but can cause itching. Significant progress has been made to improve our understanding of the fundamental neurobiology of itch; however, much remains unknown about the mechanisms of opioid-induced pruritus. The prevention and treatment of opioid-induced pruritus remains a challenge in the field of pain management. The objective of this narrative review is to present and discuss the current body of literature and summarize the current understanding of the mechanisms underlying opioid-induced pruritus, and its relationship to analgesia, and possible treatment options.The incidence of opioid-induced pruritus differs with different opioids and routes of administration, and the various mechanisms can be broadly divided into peripheral and central. Especially central mechanisms are intricate, even at the level of the spinal dorsal horn. There is evidence that opioid receptor antagonists and mixed agonist and antagonists, especially μ-opioid antagonists and κ-opioid agonists, are effective in relieving opioid-induced pruritus. Various treatments have been used for opioid-induced pruritus; however, most of them are controversial and have conflicting results.The use of a multimodal analgesic treatment regimen combined with a mixed antagonist and κ agonists, especially μ-opioid antagonists, and κ-opioid agonists, seems to be the current best treatment modality for the management of opioid-induced pruritus and pain.Opioids remain the gold standard for the treatment of moderate to severe acute pain as well as cancer pain. It is well known that opioid-induced pruritus often does not respond to regular antipruritic treatment, thereby posing a challenge to clinicians in the field of pain management. We believe that our review makes a significant contribution to the literature, as studies on the mechanisms of opioid-induced pruritus and effective management strategies are crucial for the management of these patients.© 2023 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®.