Stanos Steven, Brodsky Marina, Argoff Charles, Clauw Daniel J, D'Arcy Yvonne, Donevan Sean, Gebke Kevin B, Jensen Mark P, Lewis Clark Evelyn, McCarberg Bill, Park Peter W, Turk Dennis C, Watt Stephen
a Swedish Pain Services , Swedish Health System , Seattle , WA , USA.
b Global Medical Affairs , Pfizer Inc ., New York , NY , USA.
Postgrad Med. 2016 Jun;128(5):502-15. doi: 10.1080/00325481.2016.1188319.
Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings.
慢性疼痛严重影响患者的功能和生活质量，并且就增加的医疗保健利用率和生产力损失而言，对整个社会都是一种负担。因此，人们越来越认识到慢性疼痛是一场公共卫生危机。然而，在慢性疼痛的预防、评估和治疗方面，临床实践仍存在很大差异。慢性疼痛的某些基本方面常常被忽视，包括与慢性疼痛相关的心理、社会和环境因素的作用。同样常被忽视的是了解当前疼痛可能的神经生物学机制以及这些机制如何指导治疗选择的重要性。最后，医生可能没有认识到利用电子病历系统收集疼痛及其对情绪、功能和睡眠影响的数据的价值。这些数据可用于在患者层面监测治疗效果的起始和维持情况，并在系统层面评估成本。在本综述中，我们解释了这些因素如何在制定针对患者特定需求的协调、循证治疗方法中发挥关键作用。我们还讨论了临床医生可以采用的一些实用方法和技巧，以加强初级保健环境中慢性疼痛患者的评估和管理。
