Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Curr Med Res Opin. 2012 Feb;28(2):249-56. doi: 10.1185/03007995.2011.651525. Epub 2012 Jan 19.
Despite limited empirical support, chronic pain has traditionally been defined mainly on the basis of its duration, which takes no account of the causative mechanisms or its clinical significance.
For this commentary on current pain management practice, the CHANGE PAIN Advisory Board considered the evidence for adopting a prognostic definition of chronic pain. The rationale underlying this approach is to take psychological and behavioural factors into account, as well as the multidimensional nature of pain. Measures of pain intensity, interference with everyday activities, role disability, depression, duration and number of pain sites are used to calculate a risk score, which indicates the likelihood of a patient having pain in the future. The consistency of a prognostic definition with the concept of integrated patient care was also considered.
When this method was compared with the number of pain days experienced over the previous 6 months--in patients with back pain, headache or orofacial pain--it was a better predictor of clinically significant pain 6 months later for all three pain conditions. Further evidence supporting this approach is that several factors other than the duration of pain have been shown to be important prognostic indicators, including unemployment, functional disability, anxiety and self-rated health. The use of a multifactorial risk score may also suggest specific measures to improve outcomes, such as addressing emotional distress. These measures should be undertaken as part of an integrated pain management strategy; chronic pain is a biopsychosocial phenomenon and all aspects of the patient's pain must be dealt with appropriately and simultaneously for treatment to be effective.
The implementation of a prognostic definition and wider adoption of integrated care could bring significant advantages. However, these measures require improved training in pain management and structural revision of specialist facilities, for which political support is essential.
尽管经验证据有限，但慢性疼痛传统上主要基于其持续时间来定义，而这种定义没有考虑到致病机制或其临床意义。
为了对当前疼痛管理实践进行评论，CHANGE PAIN 顾问委员会考虑了采用慢性疼痛预后定义的证据。这种方法的基本原理是考虑心理和行为因素以及疼痛的多维性质。使用疼痛强度、日常生活活动干扰、角色残疾、抑郁、疼痛持续时间和疼痛部位数量等指标来计算风险评分，该评分表明患者未来疼痛的可能性。还考虑了预后定义与综合患者护理概念的一致性。
当将这种方法与过去 6 个月中经历的疼痛天数（腰痛、头痛或颌面痛患者）进行比较时，它是三种疼痛情况 6 个月后临床显著疼痛的更好预测指标。支持这种方法的进一步证据是，除了疼痛持续时间之外，许多其他因素已被证明是重要的预后指标，包括失业、功能残疾、焦虑和自我评估健康。使用多因素风险评分还可能提示改善结果的具体措施，例如解决情绪困扰。这些措施应作为综合疼痛管理策略的一部分；慢性疼痛是一种生物心理社会现象，必须适当和同时处理患者疼痛的所有方面，才能使治疗有效。
实施预后定义和更广泛地采用综合护理可能会带来显著优势。然而，这些措施需要在疼痛管理方面进行改进培训，并对专门设施进行结构修订，为此需要政治支持。
