Center for Bioethics Pain Management and Medicine, St. Louis, MO, USA,
Pain Ther. 2015 Jun;4(1):17-32. doi: 10.1007/s40122-015-0031-0. Epub 2015 Jan 28.
Chronic pain is a complex disorder with multiple etiologies for which the pathologic mechanisms are still largely unknown, making effective treatment a difficult clinical task. Achieving pain relief along with improved function and quality of life is the primary goal of pain clinicians; however, most patients and healthcare professionals consider 30% pain improvement to be clinically significant-a success level that would be unacceptable in other areas of medicine. Furthermore, patients with chronic pain frequently have multiple comorbidities, including depression and sleep apnea, and most have seen several physicians prior to being seen by a pain specialist, have more than three specific pain generators, and are taking multiple medications. The addition of further oral medications to control pain increases the risk of drug-drug interactions and side effects. However, topical analgesics have the advantage of local application with limited systemic levels of drug. Topical therapies benefit from reduced side effects, lower risk of drug-drug interactions, better patient acceptability/compliance, and improved tolerability. This two-part paper is a review of topical analgesics and their potential role in the treatment of chronic pain.
慢性疼痛是一种复杂的疾病，其病因有多种，病理机制在很大程度上仍不明确，这使得有效治疗成为一项艰巨的临床任务。缓解疼痛，同时改善功能和生活质量，是疼痛临床医生的主要目标；然而，大多数患者和医疗保健专业人员认为疼痛减轻 30%具有临床意义——在医学的其他领域，这一成功率是不可接受的。此外，慢性疼痛患者常伴有多种合并症，包括抑郁和睡眠呼吸暂停，而且大多数患者在接受疼痛专家治疗之前已经看过几位医生，有三个以上特定的疼痛病灶，并且正在服用多种药物。为了控制疼痛而增加其他口服药物会增加药物相互作用和副作用的风险。然而，局部镇痛药具有局部应用的优势，药物在全身的水平有限。局部治疗的好处包括减少副作用、降低药物相互作用的风险、提高患者的接受度/依从性以及改善耐受性。这篇由两部分组成的论文是对局部镇痛药及其在慢性疼痛治疗中的潜在作用的综述。
