Department of Anesthesiology, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA.
Pain Med. 2010 Dec;11(12):1859-71. doi: 10.1111/j.1526-4637.2010.00983.x. Epub 2010 Oct 28.
Intense acute pain afflicts millions of patients each year. Despite the recently increased focus on the importance of pain control, management of acute pain has remained suboptimal.
The objective of this study was to identify through a review of recent literature the barriers to effective treatment of acute pain and the potential consequences of inadequate pain management.
A comprehensive literature review was conducted to identify articles relevant to the management of acute pain. Information regarding the underlying causes of inadequate pain management, as well as the sequelae associated with undermanaged pain was extracted and summarized.
Studies indicate that treatment of acute pain remains suboptimal due to attitudes and educational barriers on the part of both physicians and patients, as well as the intrinsic limitations of available therapies. Inadequate management of acute pain negatively impacts numerous aspects of patient health, and may increase the risk of developing chronic pain. Although opioids are the preferred treatment for most moderate to severe acute pain, their side effects can impede their use, and thus, their clinical effectiveness. Analgesic regimens with an improved efficacy/tolerability balance have the potential to improve acute pain management, and thus reduce the incidence of chronic pain. Studies examining the use of multiple analgesics with different mechanisms of action suggest that multimodal therapies may offer an improved efficacy/tolerability balance over single agent regimens.
There exists a significant need for effective, well-tolerated analgesic therapies to limit the negative consequences of undermanaged acute pain. The use of multimodal therapy has demonstrated increasing promise and is supported by current practice guidelines.
每年都有数百万人遭受剧烈的急性疼痛。尽管最近越来越重视疼痛控制的重要性，但急性疼痛的管理仍然不尽如人意。
本研究的目的是通过对近期文献的回顾，确定有效治疗急性疼痛的障碍以及管理不善的潜在后果。
进行了全面的文献回顾，以确定与急性疼痛管理相关的文章。提取并总结了有关管理不善的疼痛的根本原因以及与管理不善的疼痛相关的后果的信息。
研究表明，由于医生和患者双方的态度和教育障碍以及现有治疗方法的固有局限性，急性疼痛的治疗仍然不尽如人意。急性疼痛管理不善会对患者健康的许多方面产生负面影响，并可能增加发展为慢性疼痛的风险。虽然阿片类药物是治疗大多数中度至重度急性疼痛的首选药物，但它们的副作用会阻碍其使用，从而降低其临床效果。具有改善的疗效/耐受性平衡的镇痛方案有可能改善急性疼痛管理，从而降低慢性疼痛的发生率。研究检查了具有不同作用机制的多种镇痛药的使用情况，表明多模式疗法可能比单一药物疗法提供更好的疗效/耐受性平衡。
需要有效的、耐受性良好的镇痛疗法来限制管理不善的急性疼痛的负面影响。多模式疗法的应用越来越有希望，并得到了当前实践指南的支持。
