Gilson Aaron M, Joranson David E, Maurer Martha A
US Policy Research, the Pain & Policy Studies Group, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
CA Cancer J Clin. 2007 Nov-Dec;57(6):341-53. doi: 10.3322/CA.57.6.341.
The National Institutes of Health reports that 100 million Americans suffer from chronic pain, including pain associated with the disease of cancer. Painful conditions can strike anyone, including cancer patients and cancer survivors. Unrelieved severe pain can limit a person's functioning and sometimes even destroy the will to live. When the quality of pain relief provided is inadequate, it is usually the result of failures to apply existing knowledge about pain and its treatment, including the appropriate use of opioids. But pain relief also can be affected by the regulatory environment and fear of being investigated for excessive prescribing. The importance of evaluating and improving policies governing pain management has been recognized by national and international authorities, including the Institute of Medicine and the World Health Organization. A pilot examination of state laws and regulatory policies demonstrated that they contained a number of outdated medical concepts and prescribing restrictions and did not contain key elements of law that can make pain management a priority for licensed medical practitioners. The Pain & Policy Studies Group developed a research program to evaluate US federal and state policy governing the medical use of pain medication. This article describes 3 national policy evaluations and how the results are being used to document improvements in state pain policies. An emerging role for clinicians and their professional organizations to improve their state's pain policies is discussed.
美国国立卫生研究院报告称，1亿美国人患有慢性疼痛，包括与癌症疾病相关的疼痛。疼痛状况可能侵袭任何人，包括癌症患者和癌症幸存者。未缓解的剧痛会限制一个人的身体机能，有时甚至会摧毁生存意志。当所提供的疼痛缓解质量不足时，通常是由于未能应用有关疼痛及其治疗的现有知识，包括未合理使用阿片类药物。但疼痛缓解也可能受到监管环境以及担心因过度开药而受到调查的影响。评估和改进疼痛管理政策的重要性已得到包括美国医学研究所和世界卫生组织在内的国家和国际权威机构的认可。对州法律和监管政策的初步审查表明，它们包含一些过时的医学概念和开药限制，且未包含能使疼痛管理成为执业医师优先事项的关键法律要素。疼痛与政策研究小组制定了一项研究计划，以评估美国联邦和州关于疼痛药物医疗使用的政策。本文介绍了三项国家政策评估以及这些结果如何被用于记录州疼痛政策的改进情况。还讨论了临床医生及其专业组织在改善所在州疼痛政策方面正在兴起的作用。
