Morawetz R F, Schreithofer D, Bostjancic G, Walter M H, Namestnik E, Benzer H
Universitätsklinik für Anaesthesie und Allgemeine Intensivmedizin, Innsbruck.
Anaesthesist. 1990 Oct;39(10):456-62.
Anesthesiologists have always played a leading role in research into pain and its treatment. Their efforts, however, have been focused on acute or postoperative pain problems. It was the American anesthesiologist John J. Bonica who fought for an increased interest in chronic pain. The establishment of the first Multidisciplinary Pain Center at the University of Washington in Seattle, the foundation of the International Association for the Study of Pain (IASP) and Melzack and Wall's now 25 year old gate control theory were the driving forces behind rapid developments in research and treatment in the area of chronic pain. The realization that chronic pain was the most frequent cause of disability in the United States also gave an impetus for new efforts in treatment. The classic anesthesiological topics, such as operative anesthesia emergency medicine and intensive care, have been extended to include acute pain services and chronic pain treatment facilities. This reflects the understanding that anesthesiological knowledge and techniques can be valuable to patients in severe acute pain and those in lingering long-term chronic pain phases. Anesthesiologists are skilled in the use of opioid narcotics and in the administration of strong analgesics. Many severe pain problems can be solved by correct use of the analgesic regimen. Special ways of administering narcotic analgesics, such as epidural infusion or patient-controlled analgesia, have already alleviated the pain problems of many patients. Anesthesiological techniques are also crucial in diagnosis. Sequential differential blockade and simple nerve blocks can be helpful in the diagnosis and classification of the pain problems. Anesthesiological contributions to a chronic pain service are not restricted to medical interventions. Organizational skills are also needed for efficient running of multidisciplinary pain treatment facilities. Clinical practice in surgical anesthesia means that anesthesiologists are experienced in interdisciplinary work and familiar with the advantages and dangers of team work. Despite international acceptance of the multidisciplinary approach to chronic pain, there is still a lack of appropriate facilities in the German-speaking countries, and we consider it important that anesthesiologists commit themselves to increasing general awareness of what is needed.
麻醉医师在疼痛及其治疗的研究中一直发挥着主导作用。然而，他们的工作重点一直是急性或术后疼痛问题。正是美国麻醉医师约翰·J·博尼卡努力推动了对慢性疼痛的更多关注。西雅图华盛顿大学首个多学科疼痛中心的建立、国际疼痛研究协会（IASP）的成立以及梅尔扎克和沃尔距今已有25年历史的闸门控制理论，是慢性疼痛领域研究和治疗快速发展的驱动力。认识到慢性疼痛是美国致残的最常见原因，也为新的治疗努力提供了动力。经典的麻醉学主题，如手术麻醉、急诊医学和重症监护，已扩展到包括急性疼痛服务和慢性疼痛治疗设施。这反映出人们认识到麻醉学知识和技术对处于严重急性疼痛中的患者以及处于长期慢性疼痛阶段的患者都可能有价值。麻醉医师擅长使用阿片类麻醉剂和给予强效镇痛药。许多严重疼痛问题可通过正确使用镇痛方案得到解决。特殊的麻醉性镇痛药给药方式，如硬膜外输注或患者自控镇痛，已经缓解了许多患者的疼痛问题。麻醉学技术在诊断中也至关重要。序贯性鉴别性阻滞和简单的神经阻滞有助于疼痛问题的诊断和分类。麻醉学对慢性疼痛服务的贡献不仅限于医疗干预。高效运营多学科疼痛治疗设施还需要组织能力。外科麻醉的临床实践意味着麻醉医师在跨学科工作方面经验丰富，熟悉团队合作的优势和风险。尽管多学科方法治疗慢性疼痛已得到国际认可，但在德语国家仍缺乏合适的设施，我们认为麻醉医师致力于提高对所需设施的普遍认识很重要。
