St George's University- Bioethics, School of Medicine, PO.Box 7, St George's, Grenada.
Dev World Bioeth. 2009 Dec;9(3):99-104. doi: 10.1111/j.1471-8847.2009.00262.x. Epub 2009 Oct 14.
This paper examines pain and pain relief in the Caribbean, where pain is widely perceived as an unavoidable part of life, and where unnecessary suffering results from untreated and under treated pain. Barriers to pain relief in the Caribbean include patient and family attitudes, inadequate knowledge among health professionals and unduly restrictive regulations on the medical use of opioids. Similar barriers exist all over the world. This paper urges medical, nursing and public health professionals, and educators to examine attitudes towards pain and pain relief and to work towards making effective pain relief and palliation more accessible. It recommends that i) health professionals and officials be better educated about pain, palliation and opioids, ii) regulatory restrictions be updated in light of clinical and scientific evidence, iii) opioid procurement policies be adjusted to facilitate increased medical use, iv) medical charts and records be modified to routinely elicit and document patients levels of pain, and v) educational campaigns be developed to inform the public that moderate and severe pain can be safely relieved at the end of life and other stages of life. The professional, respectful, and beneficent response to patients in pain is to provide rapid and aggressive pain relief or to urgently consult a pain or palliative specialist. When a health system hinders such efforts the ethical response is to identify, facilitate and advocate for overcoming barriers to improvement.
本文探讨了加勒比地区的疼痛和疼痛缓解问题，在该地区，人们普遍认为疼痛是生活中不可避免的一部分，由于未治疗和治疗不足的疼痛而导致不必要的痛苦。加勒比地区缓解疼痛的障碍包括患者和家属的态度、卫生专业人员知识不足以及对阿片类药物医疗用途的过度限制规定。类似的障碍在世界各地都存在。本文敦促医疗、护理和公共卫生专业人员以及教育工作者审视对疼痛和疼痛缓解的态度，并努力使有效的疼痛缓解和姑息治疗更容易获得。本文建议：i）更好地教育卫生专业人员和官员有关疼痛、缓解疼痛和阿片类药物的知识；ii）根据临床和科学证据更新监管限制；iii）调整阿片类药物采购政策，以促进更多的医疗用途；iv）修改医疗图表和记录，以常规地收集和记录患者的疼痛程度；v）制定教育活动，让公众了解在生命末期和其他生命阶段可以安全缓解中度和重度疼痛。对疼痛患者的专业、尊重和有益的回应是提供快速和积极的疼痛缓解，或紧急咨询疼痛或姑息治疗专家。当卫生系统阻碍这些努力时，合乎道德的回应是确定、促进和倡导克服改进障碍。
