Willimann Patrick
Schmerzambulatorium, Institut für Anästhesiologie, Universitätsspital Zürich.
Ther Umsch. 2011 Sep;68(9):512-6. doi: 10.1024/0040-5930/a000204.
The pharmacological treatment of chronic pain differs from acute pain management. In chronic non-cancer pain patients pharmacological treatment is only one element of an interdisciplinary approach. Not pain reduction only but gain in physical and social functioning is mandatory for continuation of therapy. The developpement of a strategy is the most important and difficult step toward an individual and sustained pharmacological pain treatment. Simple practical guidelines can help to find an individual therapeutic straight. Outcome parameters have to be determined. Check-ups for discontinuation of the therapy have to be done periodically. Exact documentation of effect and side effects prevents ungrateful and potential dangerous treatments. The WHO ladder remains the cornerstone of pharmacological pain treatment. Further analgesics as antidepressants and anticonvulsants are important in treatment of neuropathic or mixed pain states. Special considerations have to be done in opioid treatment of non-cancer pain regarding the lack of evidence in long term outcome and possible side effects and risks.
慢性疼痛的药物治疗不同于急性疼痛的管理。在慢性非癌性疼痛患者中，药物治疗只是多学科方法的一个要素。对于持续治疗而言，不仅要减轻疼痛，而且身体和社会功能的改善也是必需的。制定策略是实现个体化和持续药物性疼痛治疗最重要且最困难的一步。简单实用的指南有助于找到个体化的治疗路径。必须确定疗效参数。必须定期进行治疗中断检查。准确记录疗效和副作用可避免无效且可能有危险的治疗。世界卫生组织的三阶梯止痛法仍然是药物性疼痛治疗的基石。其他镇痛药如抗抑郁药和抗惊厥药在神经性或混合性疼痛状态的治疗中很重要。在非癌性疼痛的阿片类药物治疗中，鉴于长期疗效缺乏证据以及可能的副作用和风险，必须进行特殊考量。
