Tal Sari, Gurevich Alexander, Guller Vladimir
Department of Internal-Geriatric Medicine, Kaplan Medical Center, Israel.
Harefuah. 2009 Jun;148(6):386-91, 411.
Chronic pain is a common, yet frequently overlooked and undertreated complaint among older patients. It may result in an impairment of the function and quality of life of these patients. Chronic pain is a syndrome, which influences and is influenced by many potential factors (physiological psychological and social), all of which require treatment to achieve an optimal clinical outcome. Effective management of chronic pain in this population is attainable, if properly recognized and treated. Reasons for inadequate pain control by clinicians include lack of training, inadequate pain assessment and reluctance to prescribe opiates. The approach to pain assessment and management is often different and more complex for older patients than for younger ones. In older people, a host of factors can impede assessment and drug management, including multiple medical problems and many potential sources of pain, sensory impairment, depression, disability and impaired cognitive function. In addition, pharmacokinetics and pharmacodynamics unique to the geriatric population make this group vulnerable to adverse medication effects. By using appropriate pharmacological combined with non-pharmacological treatment, it is often possible to improve function ability to a greater extent than the severity of pain reduced.
慢性疼痛在老年患者中很常见，但却常常被忽视和治疗不足。它可能会导致这些患者的功能受损和生活质量下降。慢性疼痛是一种综合征，受许多潜在因素（生理、心理和社会因素）影响且会对这些因素产生影响，所有这些因素都需要治疗才能实现最佳临床效果。如果能得到正确认识和治疗，这一人群的慢性疼痛是可以有效管理的。临床医生对疼痛控制不足的原因包括缺乏培训、疼痛评估不充分以及不愿开具阿片类药物。与年轻患者相比，老年患者的疼痛评估和管理方法通常有所不同且更为复杂。在老年人中，许多因素会妨碍评估和药物管理，包括多种医疗问题和许多潜在的疼痛来源、感觉障碍、抑郁、残疾以及认知功能受损。此外，老年人群特有的药代动力学和药效学使该群体易受药物不良反应的影响。通过使用适当的药物治疗并结合非药物治疗，通常可以在更大程度上改善功能能力，而不仅仅是减轻疼痛的严重程度。
