Fechtel Scot Gerald
Cascade Neurology, 960 North 16th Street, Springfield, OR 97477, USA.
Phys Med Rehabil Clin N Am. 2006 May;17(2):303-14. doi: 10.1016/j.pmr.2005.12.008.
Treating pain patients is difficult. The usual problems encountered in providing coherent and effective treatment for any chronic medical illness are compounded in painful conditions by time, society's choices, and the cultural role of the patient. Effective treatment of these patients depends on the persistence of the clinician. We must persist in requiring a complete history to understand the patient and his or her problem. We must persist in performing a thorough physical examination to uncover sufficient under-standing of the patient's physiology. We must persist in developing a comprehensive treatment plan to cover all of the intervening concerns. We must persist in following the patient in the clinic to make sure that the plan is completed and that complications that arise are dealt with efficiently. This can lead to considerable satisfaction and frustration. There remain many unanswered questions in the evaluation of pain patients and of pain itself. How accurate is physical examination in providing information about a given patient that is relevant to treating pain? Can physical examination reliably elicit a nociceptive focus for a specific individual's chronic pain experience? Is all long-term pain a smorgasbord of nociceptive, central sensitization, and neuromodulatory mechanisms? Can acute pain be more consistently aborted to minimize the development of chronic pain? Over the next few years, as our expanding knowledge of neuropharmacology, neurophysiology, and pain modulation in the CNS combines with better understanding of pain psychology and sociology, we clinicians will expect to have happier and more productive patients.
治疗疼痛患者并非易事。在为任何慢性疾病提供连贯且有效的治疗过程中通常会遇到的问题，在疼痛病症中因时间、社会的选择以及患者的文化角色而变得更加复杂。对这些患者进行有效治疗取决于临床医生的坚持。我们必须坚持获取完整的病史，以了解患者及其问题。我们必须坚持进行全面的体格检查，以充分了解患者的生理状况。我们必须坚持制定全面的治疗计划，以涵盖所有相关问题。我们必须坚持在诊所跟踪患者，以确保治疗计划得以完成，并且有效处理出现的并发症。这可能会带来相当大的满足感和挫败感。在疼痛患者的评估以及疼痛本身方面，仍有许多问题尚无答案。体格检查在提供与治疗疼痛相关的特定患者信息时有多准确？体格检查能否可靠地找出特定个体慢性疼痛体验的伤害性刺激源？所有的长期疼痛是否都是伤害性刺激、中枢敏化和神经调节机制的大杂烩？能否更持续地缓解急性疼痛，以尽量减少慢性疼痛的发生？在未来几年，随着我们对神经药理学、神经生理学以及中枢神经系统疼痛调节的认识不断扩展，再加上对疼痛心理学和社会学有了更好的理解，我们临床医生有望拥有更快乐、更有成效的患者。
