Ruoff Gary E
Department of Family Practice, Michigan State University College of Medicine, East Lansing, USA.
Semin Arthritis Rheum. 2002 Dec;32(3 Suppl 1):43-50. doi: 10.1053/sarh.2002.37214.
Effective management of chronic pain in the elderly has posed a formidable challenge to the medical community. Practicing physicians are confronted with the complexity of controlling chronic pain in a patient population that often presents with multiple health problems and side effects from long-term use of pain medications. This study presents an overview of commonly encountered barriers to effective management of pain in the elderly and suggests strategies to optimize treatment in this patient population. A high incidence of comorbidities in the elderly frequently necessitates the use of multiple therapies, the combination of which potentially increases the toxicity experienced by this population, which is already particularly susceptible to medication side effects. When determining optimal strategy for managing chronic pain in the elderly, particular attention needs to be paid to past medical history and use of over-the-counter medications. In addition, careful monitoring of age-related changes in physiologic functions is needed, as they may impact drug plasma concentrations and increase susceptibility to adverse events. When traditional pharmacologic agents (such as acetaminophen and nonselective nonsteroidal anti-inflammatory drugs) are deemed inappropriate in high-risk patients because of ineffectiveness or side effects, physicians must consider the use of alternative drugs, such as coxibs, which have comparable efficacy to traditional analgesics, with a superior side effects profile.
老年人慢性疼痛的有效管理给医学界带来了巨大挑战。执业医生在控制老年患者慢性疼痛时面临诸多复杂情况，这些患者常常存在多种健康问题，且长期使用止痛药物会产生副作用。本研究概述了老年人有效疼痛管理中常见的障碍，并提出了优化该患者群体治疗的策略。老年人中合并症的高发病率常常需要采用多种治疗方法，而这些方法的联合使用可能会增加该群体所经历的毒性，因为他们本来就特别容易受到药物副作用的影响。在确定管理老年人慢性疼痛的最佳策略时，需要特别关注既往病史和非处方药物的使用情况。此外，需要仔细监测与年龄相关的生理功能变化，因为这些变化可能会影响药物血浆浓度，并增加发生不良事件的易感性。当传统药物（如对乙酰氨基酚和非选择性非甾体抗炎药）因无效或副作用而被认为不适用于高危患者时，医生必须考虑使用替代药物，如昔布类药物，其疗效与传统镇痛药相当，但副作用较小。
