Hawkins Seth C, Smeeks Frank, Hamel John
Mountain Emergency Physicians-Blue Ridge HealthCare, Morganton, North Carolina, USA.
J Emerg Med. 2008 Feb;34(2):125-9. doi: 10.1016/j.jemermed.2007.07.001. Epub 2007 Nov 9.
Pain is one of the most prevalent conditions treated by Emergency Physicians, although it remains contested how to interpret, measure, and treat this condition. In particular, there is controversy over how to identify and treat patients with chronic under-treated pain and those who are potentially malingering (drug-seeking). This article discusses currently accepted paradigms for treating potentially malingering patients, difficulties some communities may have when these paradigms are applied, and the results of implementing pain treatment guidelines that limit opioid use. Systematically limiting opioids via these guidelines was not associated with a decrease in overall patient satisfaction, patient satisfaction with pain management, overall volume, or volume of patients with potential drug-seeking diagnoses. Emergency Physicians' perception of quality of care delivered, as well as job satisfaction, increased after implementation of the guidelines.
疼痛是急诊科医生治疗的最常见病症之一，尽管在如何解释、测量和治疗这种病症方面仍存在争议。特别是，在如何识别和治疗慢性疼痛治疗不足的患者以及那些可能伪装（寻求药物）的患者方面存在争议。本文讨论了目前公认的治疗可能伪装患者的范例、一些社区在应用这些范例时可能遇到的困难，以及实施限制阿片类药物使用的疼痛治疗指南的结果。通过这些指南系统地限制阿片类药物的使用与患者总体满意度、患者对疼痛管理的满意度、总体就诊量或有潜在寻求药物诊断的患者数量的减少无关。实施指南后，急诊科医生对所提供医疗质量的认知以及工作满意度有所提高。
