Haanpää Maija L, Backonja Misha-Miroslav, Bennett Michael I, Bouhassira Didier, Cruccu Giorgio, Hansson Per T, Jensen Troels Staehelin, Kauppila Timo, Rice Andrew S C, Smith Blair H, Treede Rolf-Detlef, Baron Ralf
Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
Am J Med. 2009 Oct;122(10 Suppl):S13-21. doi: 10.1016/j.amjmed.2009.04.006.
Management of patients presenting with chronic pain is a common problem in primary care. Essentially, the classification of chronic pain falls into 3 broad categories: (1) pain owing to tissue disease or damage (nociceptive pain), (2) pain caused by somatosensory system disease or damage (neuropathic pain), and (3) pain without a known somatic background. Key challenges in developing a targeted holistic approach to treatment include appropriate diagnosis of the cause or causes of pain; identifying the type of pain and assessing the relative importance of its various components; and determining appropriate treatment. In clinical examination, sensory abnormalities are the crucial findings leading to a diagnosis of neuropathic pain, for which pharmacotherapy with antidepressants and anticonvulsants represents the cornerstone of medical treatment. Chronic neuropathic pain is underrecognized and undertreated, yet primary care physicians are uniquely placed on the frontlines of patient management, where they can play a pivotal role in treatment and prevention through diagnosis, therapy, follow-up, and referral. This review provides guidance in understanding and identifying the neuropathic contribution to pain presenting in primary care; assessing its severity through patient history, physical examination, and appropriate diagnostic tests; and establishing a rational treatment plan.
慢性疼痛患者的管理是初级保健中的常见问题。本质上，慢性疼痛的分类大致可分为三大类：(1) 由组织疾病或损伤引起的疼痛（伤害感受性疼痛），(2) 由躯体感觉系统疾病或损伤引起的疼痛（神经性疼痛），以及 (3) 无已知躯体背景的疼痛。制定有针对性的整体治疗方法的关键挑战包括对疼痛的病因进行恰当诊断；确定疼痛类型并评估其各个组成部分的相对重要性；以及确定合适的治疗方法。在临床检查中，感觉异常是导致神经性疼痛诊断的关键发现，抗抑郁药和抗惊厥药的药物治疗是其医学治疗的基石。慢性神经性疼痛未得到充分认识和治疗，然而初级保健医生处于患者管理的前沿，他们可以通过诊断、治疗、随访和转诊在治疗和预防中发挥关键作用。本综述为理解和识别初级保健中疼痛的神经性因素、通过患者病史、体格检查和适当的诊断测试评估其严重程度以及制定合理的治疗计划提供指导。
