Rupp Timothy, Delaney Kathleen A
Department of Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
Ann Emerg Med. 2004 Apr;43(4):494-503. doi: 10.1016/j.annemergmed.2003.11.019.
Review of emergency department pain management practices demonstrates pain treatment inconsistency and inadequacy that extends across all demographic groups. This inconsistency and inadequacy appears to stem from a multitude of potentially remediable practical and attitudinal barriers that include (1) a lack of educational emphasis on pain management practices in nursing and medical school curricula and postgraduate training programs; (2) inadequate or nonexistent clinical quality management programs that evaluate pain management; (3) a paucity of rigorous studies of populations with special needs that improve pain management in the emergency department, particularly in geriatric and pediatric patients; (4) clinicians' attitudes toward opioid analgesics that result in inappropriate diagnosis of drug-seeking behavior and inappropriate concern about addiction, even in patients who have obvious acutely painful conditions and request pain relief; (5) inappropriate concerns about the safety of opioids compared with nonsteroidal anti-inflammatory drugs that result in their underuse (opiophobia); (6) unappreciated cultural and sex differences in pain reporting by patients and interpretation of pain reporting by providers; and (7) bias and disbelief of pain reporting according to racial and ethnic stereotyping. This article reviews the literature that describes the prevalence and roots of oligoanalgesia in emergency medicine. It also discusses the regulatory efforts to address the problem and their effect on attitudes within the legal community.
对急诊科疼痛管理实践的回顾表明，疼痛治疗存在不一致性和不足，且这种情况在所有人口群体中都存在。这种不一致性和不足似乎源于众多潜在可补救的实际和态度障碍，包括：（1）护理和医学院课程以及研究生培训项目中对疼痛管理实践缺乏教育重点；（2）评估疼痛管理的临床质量管理项目不足或不存在；（3）对改善急诊科疼痛管理的特殊需求人群的严格研究匮乏，尤其是老年和儿科患者；（4）临床医生对阿片类镇痛药的态度导致对寻求药物行为的不当诊断以及对成瘾的不当担忧，即使在有明显急性疼痛状况并请求缓解疼痛的患者中也是如此；（5）与非甾体抗炎药相比，对阿片类药物安全性的不当担忧导致其使用不足（阿片恐惧症）；（6）患者疼痛报告中的文化和性别差异以及提供者对疼痛报告解读方面未得到重视；（7）根据种族和民族刻板印象对疼痛报告存在偏见和怀疑。本文回顾了描述急诊医学中镇痛不足的患病率和根源的文献。它还讨论了为解决该问题所做的监管努力及其对法律界态度的影响。
