Dureja Gur Prasad, Iyer Rajagopalan N, Das Gautam, Ahdal Jaishid, Narang Prashant
Delhi Pain Management Centre, New Delhi, Delhi.
Department of Orthopaedics, Raja Rajeswari Medical College and Hospital, Bengaluru, Karnataka.
J Pain Res. 2017 Mar 29;10:709-736. doi: 10.2147/JPR.S128655. eCollection 2017.
Despite enormous progress in the field of pain management over the recent years, pain continues to be a highly prevalent medical condition worldwide. In the developing countries, pain is often an undertreated and neglected aspect of treatment. Awareness issues and several misconceptions associated with the use of analgesics, fear of adverse events - particularly with opioids and surgical methods of analgesia - are major factors contributing to suboptimal treatment of pain. Untreated pain, as a consequence, is associated with disability, loss of income, unemployment and considerable mortality; besides contributing majorly to the economic burden on the society and the health care system in general. Available guidelines suggest that a strategic treatment approach may be helpful for physicians in managing pain in real-world settings. The aim of this manuscript is to propose treatment recommendations for the management of different types of pain, based on the available evidence. Evidence search was performed by using MEDLINE (by PubMed) and Cochrane databases. The types of articles included in this review were based on randomized control studies, case-control or cohort studies, prospective and retrospective studies, systematic reviews, meta-analyses, clinical practice guidelines and evidence-based consensus recommendations. Articles were reviewed by a multidisciplinary expert panel and recommendations were developed. A stepwise treatment algorithm-based approach based on a careful diagnosis and evaluation of the underlying disease, associated comorbidities and type/duration of pain is proposed to assist general practitioners, physicians and pain specialists in clinical decision making.
尽管近年来疼痛管理领域取得了巨大进展，但疼痛在全球范围内仍然是一种非常普遍的医学状况。在发展中国家，疼痛往往是治疗中未得到充分治疗和被忽视的方面。与使用镇痛药相关的认知问题和一些误解、对不良事件的恐惧——尤其是对阿片类药物和手术镇痛方法的恐惧——是导致疼痛治疗效果不佳的主要因素。因此，未治疗的疼痛会导致残疾、收入损失、失业和相当高的死亡率；此外，它还总体上给社会和医疗保健系统带来巨大经济负担。现有指南表明，一种战略治疗方法可能有助于医生在现实环境中管理疼痛。本手稿的目的是根据现有证据，为不同类型疼痛的管理提出治疗建议。通过使用MEDLINE（通过PubMed）和Cochrane数据库进行证据检索。本综述纳入的文章类型基于随机对照研究、病例对照或队列研究、前瞻性和回顾性研究、系统评价、荟萃分析、临床实践指南和基于证据的共识建议。文章由多学科专家小组进行评审并制定建议。提出了一种基于逐步治疗算法的方法，该方法基于对潜在疾病、相关合并症以及疼痛类型/持续时间的仔细诊断和评估，以协助全科医生、内科医生和疼痛专家进行临床决策。
