Service de Rhumatologie, CHU Dupuytren, Limoges, France.
Curr Med Res Opin. 2013 Jun;29(6):653-9. doi: 10.1185/03007995.2013.791264. Epub 2013 Apr 17.
To determine how the origin of acute pain influences its semiological characteristics, and to evaluate the efficacy and safety of two Level 2 analgesic combinations in general practice.
This prospective, observational, multicenter study enrolled patients who consulted general practitioners across France for intense pain that lasted ≥7 days and for which the physician prescribed paracetamol-codeine or paracetamol-tramadol. Completed physician (Day 0) and patient (Days 0-3 and Days 4-7) questionnaires provided data on the origin, characteristics, impact, and treatment of the pain, during the 7 days after the initial consultation.
Pain intensity (0-10 unidimensional numerical scale), type (SF-MPQ) and impact on quality of life (QoL; SF-12).
Overall, 1003 patient questionnaires were completed for Days 0-3 and 941 for Days 4-7. The origin of pain was most commonly disease or trauma. Mean baseline pain intensity was 7 (SD 1.3; 0-10 numerical rating scale), and was similar regardless of the origin. The time-course of pain differed according to its origin: more than two-thirds of patients with trauma/work accident related pain described it as being constant, whereas 43% of those with disease-related pain described it as recurrent/intermittent. The origin of pain also influenced its QoL impact: trauma/work accident related pain led to functional and/or professional temporary incapacity in 77% and 83% of patients (vs 63% for disease-related pain), while disease-related pain led to a change in mood and/or feeling of anxiety in 79% of patients (vs 47% [trauma] and 58% [work accident related]). Both paracetamol-codeine and paracetamol-tramadol reduced pain intensity by approximately 75% and were well tolerated. Key limitations relate to the observational study design, countered by advantages gained from the 'real life' evaluation of acute pain and its treatment in a general medical practice setting.
Acute pain should not be understood as a single entity but as multiple entities with specific characteristics related to its underlying origin. Furthermore, our data suggest that, as already demonstrated in clinical trials, Level 2 analgesia provides effective relief of acute pain in 'real life' conditions.
确定急性疼痛的起源如何影响其症状特征，并评估两种二级镇痛组合在一般实践中的疗效和安全性。
这是一项前瞻性、观察性、多中心研究，招募了因持续≥7 天的剧烈疼痛而向法国各地的全科医生就诊的患者，医生为这些患者开具了对乙酰氨基酚-可待因或对乙酰氨基酚-曲马多。在初始就诊后 7 天内，完成的医生（第 0 天）和患者（第 0-3 天和第 4-7 天）问卷提供了疼痛的起源、特征、影响和治疗的数据。
疼痛强度（0-10 一维数字量表）、类型（SF-MPQ）和对生活质量的影响（SF-12）。
总体而言，有 1003 名患者完成了第 0-3 天的问卷，941 名患者完成了第 4-7 天的问卷。疼痛的起源最常见的是疾病或外伤。基线疼痛强度的平均值为 7（SD 1.3；0-10 数字评分量表），且与起源无关。疼痛的时间进程因起源而异：超过三分之二的创伤/工作事故相关疼痛患者描述为持续疼痛，而 43%的疾病相关疼痛患者描述为反复发作/间歇性疼痛。疼痛的起源也影响其对生活质量的影响：创伤/工作事故相关疼痛导致 77%和 83%的患者出现功能性和/或职业性暂时丧失能力（疾病相关疼痛为 63%），而疾病相关疼痛导致 79%的患者情绪和/或焦虑感改变（创伤为 47%，工作事故相关为 58%）。对乙酰氨基酚-可待因和对乙酰氨基酚-曲马多均能使疼痛强度降低约 75%，且耐受性良好。主要局限性与观察性研究设计有关，但通过在一般医疗实践环境中对急性疼痛及其治疗进行“真实生活”评估，获得了优势。
急性疼痛不应被理解为一种单一的实体，而应被理解为与潜在起源相关的具有特定特征的多种实体。此外，我们的数据表明，正如临床试验已经证明的那样，二级镇痛在“真实生活”条件下提供了急性疼痛的有效缓解。
