Weiner D K, Hanlon J T
Division of Geriatric Medicine, University of Pittsburgh, Philadelphia 15213, USA.
Drugs Aging. 2001;18(1):13-29. doi: 10.2165/00002512-200118010-00002.
Pain is prevalent and undertreated in nursing home residents, despite the existing wide array of effective pharmacological and nonpharmacological treatment modalities. In order to improve the quality of life of these vulnerable individuals, practitioners require education about the correct approach to assessment and management. Assessment should be comprehensive, taking into account the basic underlying pathology (e.g. osteoarthritis, osteoporosis, peripheral neuropathy, fibromyalgia, cancer) as well as other contributory pathology (e.g. muscle spasm, myofascial pain) and modifying comorbidities (e.g. depression, anxiety, fear, sleep disturbance). Pharmacological management should be guided by a stepped-care approach, modelled after that recommended by the World Health Organization for treatment of cancer pain. Nonopioid and opioid analgesics are the cornerstone of pharmacological pain management. Tricyclic antidepressants and anticonvulsants can be very effective for the treatment of certain types of neuropathic pain. In addition to treating the pain per se, attention should be given to prevention of disease progression and exacerbation, as maintaining function is of prime importance. Nursing home residents with severe dementia challenge the practitioner's pain assessment skills; an empirical approach to treatment may sometimes be warranted. The success of treatment should be measured by improvement in pain intensity as well as physical, psychosocial and cognitive function. Effective pain management may impact any or all of these functional domains and, therefore, substantially improve the nursing home resident's quality of life.
尽管现已有大量有效的药物和非药物治疗方式，但疼痛在疗养院居民中仍然普遍存在且治疗不足。为了提高这些弱势群体的生活质量，从业者需要接受有关正确评估和管理方法的教育。评估应全面，要考虑到基本的潜在病理状况（如骨关节炎、骨质疏松症、周围神经病变、纤维肌痛、癌症）以及其他促成病理状况（如肌肉痉挛、肌筋膜疼痛）和合并症（如抑郁、焦虑、恐惧、睡眠障碍）。药物管理应以阶梯式护理方法为指导，该方法仿照世界卫生组织推荐的癌症疼痛治疗方法制定。非阿片类和阿片类镇痛药是药物性疼痛管理的基石。三环类抗抑郁药和抗惊厥药对某些类型的神经性疼痛治疗可能非常有效。除了治疗疼痛本身外，还应注意预防疾病进展和加重，因为维持功能至关重要。患有严重痴呆症的疗养院居民对从业者的疼痛评估技能构成挑战；有时可能需要采用经验性治疗方法。治疗的成功应以疼痛强度以及身体、心理社会和认知功能的改善来衡量。有效的疼痛管理可能会影响这些功能领域中的任何一个或全部，因此，可大幅提高疗养院居民的生活质量。
