Katz W A
Department of Medicine, Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, USA.
Clin Rheumatol. 2002 Feb;21 Suppl 1:S2-4. doi: 10.1007/s100670200028.
Pain is the most common reason for patients seeking advice from their physician. One adult in five suffers from chronic pain. In general, musculoskeletal pain, often in the form of arthritis, non-articular rheumatism, peripheral neuropathies and low back disorders, represents the most common cause of chronic non-malignant pain (CNMP). Exposure to low social support, low social anchorage or low social participation significantly increases the odds of a high level of pain. Most patients do not attribute chronic musculoskeletal pain to injury, but those who do report significantly higher levels of emotional distress. Pain is the third leading reason for absence from work in the United States, where the problem of chronic pain translates into an annual expenditure of at least $50 billion. The effectiveness of opioids for chronic pain goes unchallenged, but issues of potential dependence, abuse, and social and legal concerns have rendered their use in CNMP controversial. Numerous consensus statements, guidelines and policies have been issued by a variety of advocate organisations for the treatment of CNMP with opioids. Undertreatment of chronic pain persists despite the availability of drugs and other therapies for effective pain management.
疼痛是患者向医生咨询的最常见原因。五分之一的成年人患有慢性疼痛。一般来说，肌肉骨骼疼痛，通常表现为关节炎、非关节性风湿病、周围神经病变和下背部疾病，是慢性非恶性疼痛（CNMP）最常见的原因。社会支持水平低、社会归属感低或社会参与度低会显著增加疼痛程度较高的几率。大多数患者并不将慢性肌肉骨骼疼痛归因于损伤，但那些这样归因的患者报告的情绪困扰水平明显更高。在美国，疼痛是导致缺勤的第三大主要原因，慢性疼痛问题每年造成的支出至少为500亿美元。阿片类药物对慢性疼痛的有效性无可争议，但潜在的依赖性、滥用以及社会和法律问题使得它们在CNMP治疗中的使用存在争议。各种倡导组织已经发布了许多关于用阿片类药物治疗CNMP的共识声明、指南和政策。尽管有药物和其他有效疼痛管理疗法，但慢性疼痛的治疗不足仍然存在。
