Musey Paul I, Linnstaedt Sarah D, Platts-Mills Timothy F, Miner James R, Bortsov Andrey V, Safdar Basmah, Bijur Polly, Rosenau Alex, Tsze Daniel S, Chang Andrew K, Dorai Suprina, Engel Kirsten G, Feldman James A, Fusaro Angela M, Lee David C, Rosenberg Mark, Keefe Francis J, Peak David A, Nam Catherine S, Patel Roma G, Fillingim Roger B, McLean Samuel A
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
Acad Emerg Med. 2014 Dec;21(12):1421-30. doi: 10.1111/acem.12529. Epub 2014 Nov 24.
Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacological and nonpharmacological interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the life span; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biological mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biological mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender differences in the assessment and treatment of pain conditions in emergency care settings.
疼痛是美国一个主要的公共卫生问题，每年造成的经济负担超过6300亿美元，也是个人寻求急诊科（ED）护理的最常见原因之一。关于急诊科急性和慢性疼痛状况评估与治疗中的性别差异，目前的数据匮乏。2014年5月，学术急诊医学共识会议在得克萨斯州达拉斯召开，旨在制定一项研究议程，以解决这一问题以及其他与急诊科性别差异相关的问题。会议召开前，来自急诊医学和疼痛研究领域的专家及利益相关者对当前文献进行了审查，并确定了八个候选优先领域。在会议上，对这八个领域进行了审查，所有八个领域均采用名义小组技术进行了批准，以达成共识。这些优先领域包括：1）疼痛的药物和非药物干预中的性别差异，包括阿片类药物耐受性、副作用或滥用方面的差异；2）疼痛严重程度感知方面的性别差异、急性疼痛中有临床意义的差异以及疼痛治疗偏好；3）急诊科患者在整个生命周期中疼痛结果的性别差异；4）急性疼痛与急性心理反应之间关系的性别差异；5）医患性别差异和特征对疼痛评估与治疗的影响；6）急性应激和慢性应激对急性疼痛反应影响的性别差异；7）急诊科人群中介导急性疼痛的生物学机制和分子途径的性别差异；8）创伤、应激或急性疾病暴露后介导慢性疼痛发展的生物学机制和分子途径的性别差异。这些领域代表了未来科学探究的优先领域，了解这些领域对于提高我们对急诊护理环境中疼痛状况评估与治疗中的性别和性别的差异的理解至关重要。
