Gloth F M
Union Memorial Hospital, Johns Hopkins University School of Medicine, Hospice Network of Maryland, Baltimore, USA.
J Am Geriatr Soc. 2001 Feb;49(2):188-99. doi: 10.1046/j.1532-5415.2001.49041.x.
The release of guidelines in 1998 by the American Geriatrics Society on "The Management of Chronic Pain in Older Persons" was a breakthrough in helping to manage pain in this population. Already advances have fostered a need to update recommendations. This article focuses on the treatment strategies available for seniors that are likely to help to fulfill the obligation to relieve pain and suffering in patients. A review was done of the literature using Medline and other search techniques. New pain scales have been developed with seniors in mind and greater testing of older scales in elderly populations have helped to identify measures of pain more suited to frail seniors. Advances in cyclooxygenase inhibition selectivity, alternative medicine, and progress in the identification of nonopioid pain receptors and the development of products to target them are just a few of changes that have altered the way clinicians think about treating pain. The use of hospice in end-of-life palliative care is a valuable resource for clinicians managing pain at that phase in care as well. Tools are available to prevent and treat pain successfully in seniors. Educating clinicians about available assessment tools, techniques and interventions may be the biggest challenge to comforting the older adult in pain.
1998年美国老年医学会发布的《老年人慢性疼痛管理》指南是帮助管理这一人群疼痛方面的一项突破。目前的进展促使人们需要更新相关建议。本文重点关注可供老年人使用的治疗策略，这些策略可能有助于履行减轻患者疼痛和痛苦的义务。使用医学在线数据库（Medline）和其他检索技术对文献进行了综述。已经开发出了针对老年人的新疼痛量表，并且在老年人群体中对旧量表进行了更多测试，这有助于确定更适合体弱老年人的疼痛测量方法。环氧化酶抑制选择性方面的进展、替代医学以及在非阿片类疼痛受体识别和针对这些受体的产品开发方面取得的进展，只是改变临床医生治疗疼痛思路的部分变化。临终姑息治疗中临终关怀的使用对于临床医生在该护理阶段管理疼痛来说也是一项宝贵资源。有一些工具可用于成功预防和治疗老年人的疼痛。让临床医生了解可用的评估工具、技术和干预措施可能是安慰疼痛老年患者面临的最大挑战。
