Università degli Studi di L'Aquila, L'Aquila, Italy.
Curr Med Res Opin. 2010 May;26(5):1231-45. doi: 10.1185/03007991003689175.
Although chronic pain affects around 20% of adults in Europe and the USA, there is substantial evidence that it is inadequately treated. In June 2009, an international group of pain specialists met in Brussels to identify the reasons for this and to achieve consensus on strategies for improving pain management.
Literature on chronic pain management was reviewed, and information presented to and discussed by a panel of experts.
It was agreed that guidelines are not universally accepted by those involved in pain management, and pain treatment seems to be driven mainly by tradition and personal experience. Other factors include poor communication between patients and physicians, the side effects of analgesic drugs, and limited individualisation of therapy. Difficulty in maintaining the balance between adequate pain relief and acceptable tolerability, particularly with strong opioids, can lead to the establishment of a 'vicious circle' that alternates between lack of efficacy and unpleasant side effects, prompting discontinuation of treatment. The medical community's understanding of the physiological differences between nociceptive pain and neuropathic pain, which is often more severe and difficult to treat, could be improved. Increasing physicians' knowledge of the pharmacological options available to manage these different pain mechanisms offers the promise of better treatment decisions and more widespread adoption of a multi-mechanistic approach; this could involve loosely combining two substances from different drug classes, or administering an analgesic with two different mechanisms of action. In some circumstances, a single compound capable of addressing both nociceptive and neuropathic pain is desirable.
To improve patient outcomes, a thorough understanding of pain mechanisms, sensitisation and multi-mechanistic management is required. Universal, user-friendly educational tools are therefore required to familiarise physicians with these topics, and also to improve communication between physicians and their pain patients, so that realistic expectations of treatment can be established.
尽管慢性疼痛影响了大约 20%的欧洲和美国成年人，但有大量证据表明，这种疼痛的治疗并不充分。2009 年 6 月，一群国际疼痛专家在布鲁塞尔开会，以找出原因，并就改善疼痛管理的策略达成共识。
对慢性疼痛管理的文献进行了回顾，并向专家组提供了信息，并由专家组进行了讨论。
专家组一致认为，指南并未被参与疼痛管理的人员普遍接受，而疼痛治疗似乎主要受传统和个人经验的驱动。其他因素包括患者与医生之间沟通不畅、镇痛药的副作用以及治疗的个体化程度有限。在充分缓解疼痛和可接受的耐受性之间保持平衡的困难，特别是对于强效阿片类药物，可能导致建立一个“恶性循环”，在疗效不足和不良副作用之间交替，从而促使治疗中断。医学界对伤害性疼痛和神经性疼痛之间生理差异的理解可以得到改善，神经性疼痛通常更严重且更难治疗。增加医生对可用于治疗这些不同疼痛机制的药理学选择的了解，有望做出更好的治疗决策，并更广泛地采用多机制方法；这可能涉及从不同药物类别中混合两种物质，或使用具有两种不同作用机制的镇痛药。在某些情况下，需要一种能够同时治疗伤害性疼痛和神经性疼痛的单一化合物。
为了改善患者的预后，需要深入了解疼痛机制、敏化和多机制管理。因此，需要通用、易于使用的教育工具，使医生熟悉这些主题，并改善医生与疼痛患者之间的沟通，从而可以建立治疗的现实期望。
