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

從肋骨骨折到背痛、到治療手術後的疼痛。

But there's a lot of misconceptions around them, so it's important to take the time to understand them better.

但人們對它們有很多誤解，所以花點時間了解是很重要的。

[Body Stuff with Dr. Jen Gunter]

[跟 Gunter 醫生一起學習身體知識]

The first misconception is that opioids are the best strongest form of pain medication.

第一個誤解是認為鴉片類藥物是最好、最有效的止痛藥。

But in almost every well-designed study, comparing opioids to anti-inflammatory drugs such as Ibuprofen,

但在幾乎所有精心設計的研究中，將鴨片類藥物與布洛芬等抗炎藥進行比較，

the anti-inflamaotories come out on top from a safety or effectiveness perspective, or both.

從安全性或有效性的角度來看，消炎藥都是名列前茅的，或者兩者都是。

Let's talk about the effectiveness first.

我們先來談談有效的程度。

How do opioids work?

鴉片類藥物是如何發揮作用的？

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

要了解這一點，我們首先要先稍微了解疼痛是如何作用的。

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

疼痛是我們的身體告訴我們出問題的方式。

You stubbed your toe, you burned your hand.

腳趾被刺傷、手被燒傷。

Pain gives us the message that it's time for us to rest, recover and treat the damage.

疼痛給我們的訊息是，我們是時候該休息、復原和治療傷害了。

In the body, pain is created by multiple chemical signals and receptors, and different medications can target different parts of that pain pathway.

在人體內，疼痛是由多種化學信號和受體產生的，不同的藥物可以針對該疼痛途徑的不同部分治療。

Medications like acetaminophen, such as Tylenol, or nonsteroidal anti-inflammatory drugs, also known as NSAIDs, like ibuprofen, aspirin, and naproxen,

藥物如對乙酰氨基酚，如泰諾，或非類固醇抗發炎藥（NSAIDS），如布洛芬、阿司匹靈和萘普生，

all treat pain in different ways from opioids.

它們治療疼痛的方式都和鴉片類藥物不同。

Opioids work by binding to and activating the opioid receptors located throughout the body, blocking pain signals.

鴉片類藥物透過與位於全身的鴉片類受體結合並刺激來截斷疼痛信號。

This activation also triggers the release of dopamine, a hormone associated with pleasure.

這種刺激也會引發多巴胺的釋出，多巴胺是一種與快樂有關的荷爾蒙。

So in addition to pain relief, some people can feel relaxed or even euphoric.

因此，除了緩解疼痛外，有些人還會感到放鬆，甚至是興奮。

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

在較高的劑量下，鴉片類藥物可以影響認知，甚至是呼吸。

But here's a really important point that people often don't know: Opioid receptors can adapt, often in a short amount of time to expect opioids.

但還有非常重要一點是，人們往往不知道鴉片類受體可以在很短的時間內就適應非鴉片類藥物。

And when a patient doesn't take them, they experience symptoms of withdrawal.

而當病人不服用這些藥物時，他們會出現戒斷症狀。

And withdrawal is very uncomfortable.

而戒斷是非常不舒服的。

People can mistake that discomfort for thinking the opioids were actually working.

人們會誤以為這種不適是鴉片類藥物真的在發揮功效。

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

但大家不知道的是，這種情況只需服用幾劑就會發生。

When you're a patient needing relief from pain, it can be confusing to know the difference.

當你是一個需要緩解疼痛的病人時，很難了解其中的差異。

All you want is to feel normal again.

你只希望一切恢復原狀。

In this way, opioids, if not used very carefully and intentionally, can create physical dependence.

這樣一來，鴉片類藥物如果不是非常謹慎且刻意地使用，就會產生生理依賴性。

They can also paradoxically worsen pain, and there's a risk of developing addiction.

它們反而會加重疼痛，而且有成癮的風險。

There's nuance here:

以下說明一些細微的差別：

People who have become physically dependent often don't even know they are.

已經產生生理依賴性的人往往甚至不知道他們成癮了。

They just know that the opioids seem to be offering relief without realizing that they could actually be contributing to the pain.

他們只知道鴉片類藥物似乎緩解了疼痛，卻沒有意識到它們其實可能才是造成疼痛的原因。

I want to be clear here: opioids can be effective, appropriate therapy, but they should be prescribed with great care.

我想解釋清楚的一點是，鴉片類藥物可以是有效的、適當的療法，但應該非常謹慎地開藥。

This is the doctor's responsibility.

這是醫生的職責。

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

我可以給大家一些建議，讓你們成為一個有醫療知識的病人。

If you or a loved one experience acute pain, ask to explore alternatives to opioids like Tylenol, NSAIDs, muscle relaxants and physical therapy,

如果你或你的親人正經歷急性疼痛並想要尋找鴉片類藥物的替代品，如泰諾、非類固醇消炎藥、肌肉鬆弛劑和物理療法，

if your doctor doesn't bring those up first, and if you or a loved one are prescribed opioids, make sure your doctor has a plan to taper you off, accounting for the risk of dependence.

如果你的醫生沒有先提出這些藥物，而你或你的親人被開了鴉片類藥物，在考慮到可能產生依賴性的情況下，記得確保你的醫生是有計劃性的開藥，並會逐步減少你的用量。

And finally, ask for naloxone; this is a drug that can reverse opioid overdose.

最後，要求醫生提供納洛酮，這是一種可以治療鴉片類藥物過量的藥物。

It can be easy to forget if you've taken a dose, and you never know who in your household could take your medication.

你可能很容易忘記你是否服用過多劑量，而且你不會知道自己人會不會服用你的藥物。

Naloxone can literally save a life.

納洛酮真的可以救人一命。

Remember, when it comes to pain, opioids are not always the most effective way to safely offer relief.

記住，當疼痛時，鴉片類藥物並不都是最有效安全的緩解方式。

And when they are prescribed, they should always be prescribed with a plan.

在開鴉片類藥物時，應該要有計劃性的開藥。