Department of Orthopaedics and Traumatology, University of Insubria, Ospedale di Circolo-Fondazione Macchi, Varese, Italy.
Clin Drug Investig. 2012 Feb 22;32 Suppl 1:35-44. doi: 10.2165/11630060-000000000-00000.
Chronic pain is a major healthcare issue in Europe and globally, and inadequate or undertreated pain significantly reduces the ability of many patients to participate in ordinary daily activities, adversely affects their employment status and contributes to a substantial rate of depression and anxiety in patients with chronic pain. There is a broad distinction of chronic pain into chronic non-cancer pain and chronic cancer pain, and important subgroups of these include patients with rheumatic and/or orthopaedic diseases, pain syndromes caused by cancer itself and caused by cancer treatment. Despite comprising the majority of non-cancer pain in Europe, chronic non-cancer pain associated with rheumatic diseases and/or orthopaedic conditions is often inadequately managed. Although paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) play a continuing role in the treatment of chronic rheumatic diseases, accumulating evidence of potential toxicity with both traditional non-selective NSAIDs and selective cyclooxygenase 2 inhibitors has prompted a reassessment of their use. This has particular resonance for the elderly, who are more likely to have significant pain issues than younger patients and are at high risk of NSAID-related adverse events. The use of mild opioids, such as codeine and tramadol, and strong opioids, such as morphine, hydromorphone and oxycodone, may be appropriate where paracetamol and other non-opioid analgesics are ineffective in chronic non-cancer pain. Cancer pain, either related to the underlying disease or caused by cancer treatment, is also a common cause of chronic pain in the elderly. An understanding of individual needs is essential in providing adequate pain relief, which is a central goal of care in all patients with chronic pain.
慢性疼痛是欧洲和全球范围内的一个主要医疗保健问题，疼痛治疗不足或不当会显著降低许多患者参与日常活动的能力，对他们的就业状况产生不利影响，并导致慢性疼痛患者中出现大量抑郁和焦虑。慢性疼痛广泛分为慢性非癌症疼痛和慢性癌症疼痛，这些疼痛的重要亚组包括患有风湿和/或骨科疾病、癌症本身和癌症治疗引起的疼痛综合征的患者。尽管在欧洲，慢性非癌症疼痛构成了大多数非癌症疼痛，但与风湿性疾病和/或骨科疾病相关的慢性非癌症疼痛往往治疗不足。虽然对乙酰氨基酚和非甾体抗炎药（NSAIDs）在慢性风湿性疾病的治疗中仍发挥着持续作用，但传统非选择性 NSAIDs 和选择性环氧化酶 2 抑制剂都存在潜在毒性的证据不断增加，促使人们重新评估它们的使用。这对于老年人尤其有共鸣，他们比年轻患者更有可能出现严重的疼痛问题，并且面临与 NSAIDs 相关的不良事件的高风险。在对乙酰氨基酚和其他非阿片类镇痛药无效的情况下，轻度阿片类药物（如可待因和曲马多）和强阿片类药物（如吗啡、氢吗啡酮和羟考酮）的使用可能是合适的。与基础疾病相关或由癌症治疗引起的癌症疼痛也是老年人慢性疼痛的常见原因。了解个人需求对于提供足够的疼痛缓解至关重要，这是所有慢性疼痛患者护理的核心目标。
