Tompkins D Andrew, Hobelmann J Greg, Compton Peggy
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia PA, USA.
Drug Alcohol Depend. 2017 Apr 1;173 Suppl 1(Suppl 1):S11-S21. doi: 10.1016/j.drugalcdep.2016.12.002.
Over 100 million Americans are living with chronic pain, and pain is the most common reason that patients seek medical attention. Despite the prevalence of pain, the practice of pain management and the scientific discipline of pain research are relatively new fields compared to the rest of medicine - contributing to a twenty-first century dilemma for health care providers asked to relieve suffering in the "Fifth Vital Sign" era.
This manuscript provides a narrative review of the basic mechanisms of chronic pain and history of chronic pain management in the United States - including the various regulatory, health system and provider factors that contributed to the decline of multidisciplinary pain treatment in favor of the predominant opioid treatment strategy seen today. Multiple non-opioid pain treatment strategies are then outlined. The manuscript concludes with three key questions to help guide future research at the intersection of pain and addiction.
The assessment and treatment of chronic pain will continue to be one of the most common functions of a health care provider. To move beyond an over reliance on opioid medications, the addiction and pain research communities must unite with chronic pain patients to increase the evidence base supporting non-opioid analgesic strategies.
超过1亿美国人患有慢性疼痛，疼痛是患者寻求医疗关注的最常见原因。尽管疼痛普遍存在，但与医学的其他领域相比，疼痛管理实践和疼痛研究的科学学科是相对较新的领域——这给在“第五生命体征”时代被要求减轻患者痛苦的医疗服务提供者带来了21世纪的困境。
本文对慢性疼痛的基本机制以及美国慢性疼痛管理的历史进行了叙述性综述——包括导致多学科疼痛治疗衰落而倾向于如今占主导地位的阿片类药物治疗策略的各种监管、卫生系统和提供者因素。随后概述了多种非阿片类疼痛治疗策略。本文最后提出了三个关键问题，以帮助指导疼痛与成瘾交叉领域的未来研究。
慢性疼痛的评估和治疗仍将是医疗服务提供者最常见的职能之一。为了不再过度依赖阿片类药物，成瘾研究界和疼痛研究界必须与慢性疼痛患者联合起来，以增加支持非阿片类镇痛策略的证据基础。
