Whitecar P S, Jonas A P, Clasen M E
Wright State University School of Medicine, Dayton, Ohio, USA.
Am Fam Physician. 2000 Feb 1;61(3):755-64.
End-of-life care can be a challenge requiring the full range of a family physician's skills. Significant pain is common but is often undertreated despite available medications and technology. Starting with an appropriate assessment and following recommended guidelines on the use of analgesics, family physicians can achieve successful pain relief in nearly 90 percent of dying patients. Physicians must overcome their own fears about using narcotics and allay similar fears in patients, families and communities. Drugs such as corticosteroids, antidepressants and anticonvulsants can also help to alleviate pain. Anticonvulsants can be especially useful in relieving neuropathic pain. Side effects of pain medications should be anticipated and treated promptly, but good pain control should be maintained. The physical, psychologic, social and spiritual needs of dying patients are best managed with a team approach. Home visits can provide comfort and facilitate the doctor-patient relationship at the end of life.
临终关怀是一项具有挑战性的工作，需要家庭医生具备全方位的技能。严重疼痛很常见，但尽管有可用的药物和技术，疼痛往往得不到充分治疗。从适当的评估开始，并遵循关于使用镇痛药的推荐指南，家庭医生可以在近90%的临终患者中成功缓解疼痛。医生必须克服自己对使用麻醉药品的恐惧，并消除患者、家庭和社区中的类似恐惧。皮质类固醇、抗抑郁药和抗惊厥药等药物也有助于减轻疼痛。抗惊厥药在缓解神经性疼痛方面可能特别有用。应预期并及时治疗止痛药物的副作用，但应保持良好的疼痛控制。临终患者的身体、心理、社会和精神需求最好通过团队协作的方式来管理。家访可以提供慰藉，并在生命末期促进医患关系。
