Gitlin M C
Tulane University School of Medicine, USA.
J La State Med Soc. 1999 Feb;151(2):93-8.
Pain is one of the foremost reasons for which people seek healthcare. The cost of pain to the American economy approximates $85 billion-$90 billion annually. Approximately one-third of Americans have some element of chronic pain. Acute and chronic pain are different entities requiring different approaches to treatment. The ability to assess chronic pain is fundamental to its management. The use of various subjective testing modalities, combined with a thorough history and physical examination and a review of pertinent laboratory data, enables the clinician to devise a management strategy. The management of chronic non-cancer pain syndrome often involves a concerted multidisciplinary endeavor that utilizes nerve block, pharmacological, psychological, surgical, and physical therapies. Trigger-point injections and sympathetic, epidural, subarachnoid, interpleural, intravenous, regional, and peripheral nerve blocks are utilized as indicated. Pharmacological management entails the use of numerous agents including nonsteroidal anti-inflammatory drugs, opioids, antidepressants, and anticonvulsants. Newer agents hold promise for facilitating the care of these patients.
疼痛是人们寻求医疗保健的首要原因之一。疼痛给美国经济造成的损失每年约为850亿至900亿美元。大约三分之一的美国人患有某种程度的慢性疼痛。急性疼痛和慢性疼痛是不同的病症，需要不同的治疗方法。评估慢性疼痛的能力是其管理的基础。使用各种主观测试方法，结合全面的病史、体格检查以及相关实验室数据的审查，使临床医生能够制定管理策略。慢性非癌性疼痛综合征的管理通常需要多学科的协同努力，包括神经阻滞、药物治疗、心理治疗、手术治疗和物理治疗。根据需要使用触发点注射以及交感神经、硬膜外、蛛网膜下腔、胸膜间、静脉、区域和周围神经阻滞。药物治疗需要使用多种药物，包括非甾体抗炎药、阿片类药物、抗抑郁药和抗惊厥药。新型药物有望为这些患者的护理提供便利。
