Streitberger Konrad, Stüber Frank, Kipfer Buchli Irène, Stamer Ulrike M
Universitätsklinik für Anästhesiologie und Schmerztherapie, Inselspital, Bern.
Ther Umsch. 2011 Aug;68(8):435-40. doi: 10.1024/0040-5930/a000189.
For drug therapy a differentiation of acute and chronic pain is essential. In emergency situations of acute abdominal pain a fast diagnosis is mandatory. Analgesia should be provided as soon as possible. The different groups of analgesics should be used according to their known effects, side effects and contraindications. Postoperative pain after abdominal surgery has to be considered as a special condition of acute abdominal pain. Main treatment options are non opioid analgesics and opioids. Opioids can be administered intravenously via patient controlled analgesia (PCA) devices. In major abdominal surgery neuroaxial analgesia, preferentially administered via an epidural catheter provides excellent pain relief with positive impact on gastrointestinal motility and patients' recovery. Because of difficulties to allocate chronic abdominal pain to a specific organ, causal treatment often turns out to be difficult. Peripheral and central sensitization, as well as an alteration of the endogenous pain modulation comes to the fore in these chronic pain conditions. Co-analgesics like anticonvulsants and antidepressants are utilized to reduce sensitization and improve the endogenous pain modulating system. Non drug approaches and alternative treatment options might be useful. In contrast, orally or transcutaneously administered opioids are the principal corner stone for the treatment of cancer pain.
对于药物治疗而言，区分急性疼痛和慢性疼痛至关重要。在急性腹痛的紧急情况下，快速诊断是必不可少的。应尽快提供镇痛治疗。不同类别的镇痛药应根据其已知疗效、副作用和禁忌证来使用。腹部手术后的疼痛必须被视为急性腹痛的一种特殊情况。主要的治疗选择是非阿片类镇痛药和阿片类药物。阿片类药物可通过患者自控镇痛（PCA）装置静脉给药。在大型腹部手术中，通过硬膜外导管优先给予的神经轴镇痛能提供出色的疼痛缓解效果，并对胃肠蠕动和患者恢复产生积极影响。由于难以将慢性腹痛归因于某个特定器官，因此因果治疗往往很困难。在这些慢性疼痛状况中，外周和中枢敏化以及内源性疼痛调节的改变变得尤为突出。抗惊厥药和抗抑郁药等辅助镇痛药被用于减轻敏化并改善内源性疼痛调节系统。非药物方法和替代治疗选择可能会有所帮助。相比之下，口服或经皮给药的阿片类药物是治疗癌痛的主要基石。
