Rheumatology Unit, L Sacco University Hospital, Milan, Italy.
Clin Drug Investig. 2012 Feb 22;32 Suppl 1:21-33. doi: 10.2165/11630050-000000000-00000.
Chronic pain is a common healthcare problem worldwide that ranks as a predominant reason for consulting a physician, yet effective management of chronic pain remains suboptimal, often resulting in unnecessary suffering and decreased quality of life, lost productivity and excessive healthcare costs. To overcome the challenges associated with the management of chronic pain, increased awareness and both patient and physician education are required. Improving physician knowledge of pain assessment and management guided by recommendations for a comprehensive, multifactorial, personalised treatment approach involving pharmacological and non-pharmacological approaches is key to achieving effective pain relief. Guidelines for the management of non-cancer and cancer pain recommend thorough patient assessment before individualized therapy based on the type and intensity of pain. The availability of mechanism-specific analgesics has facilitated improvements in the treatment of chronic non-cancer pain, which may be of neuropathic, muscle, inflammatory, mechanical/compressive or mixed origin. Stepwise escalation of analgesic therapy (paracetamol, non-steroidal anti-inflammatory drugs, mild to strong opioids) according to the World Health Organization's three-step pain ladder remains the standard approach for the selection of treatment for chronic cancer pain, although there is now a greater awareness of the requirements for effective administration of opioids including dose titration, use of short versus long-acting opioids, opioid rotation, management of adverse effects, and ongoing monitoring. Selection of an effective, appropriate, personalized analgesic regimen for patients with chronic pain is achievable and is expected to enhance compliance, overall functioning and quality of life.
慢性疼痛是全球常见的医疗保健问题，是患者就诊的主要原因之一，但慢性疼痛的有效管理仍不尽如人意，常导致不必要的痛苦和生活质量下降、生产力丧失和医疗费用过高。为了克服慢性疼痛管理方面的挑战，需要提高认识并对患者和医生进行教育。提高医生对疼痛评估和管理的认识，根据全面、多因素、个性化的治疗方法建议，包括药物和非药物方法，是实现有效止痛的关键。非癌症和癌症疼痛管理指南建议在基于疼痛类型和强度的个体化治疗之前，对患者进行全面评估。特定机制的镇痛药的出现促进了慢性非癌症疼痛的治疗改善，这些疼痛可能是神经性、肌肉性、炎症性、机械/压迫性或混合性的。根据世界卫生组织的三步止痛阶梯，逐步升级镇痛治疗（对乙酰氨基酚、非甾体抗炎药、弱阿片类药物到强阿片类药物）仍然是慢性癌症疼痛治疗选择的标准方法，尽管现在人们更加意识到有效管理阿片类药物的要求，包括剂量滴定、使用短效与长效阿片类药物、阿片类药物轮换、不良反应管理和持续监测。为慢性疼痛患者选择有效、适当、个性化的镇痛方案是可行的，预计将提高依从性、整体功能和生活质量。
