Adler Jeremy A, Lotz Neona M
Pacific Pain Medicine Consultants, Encinitas.
Cypress Ambulatory Surgery Center, Santa Maria, CA, USA.
J Pain Res. 2017 Nov 3;10:2565-2575. doi: 10.2147/JPR.S142147. eCollection 2017.
Physician assistants (PAs), nurse practitioners (NPs), and registered nurses (RNs) provide professional services on pain management teams. This review provides an overview of the practical management of chronic pain with intrathecal (IT) therapy using an interprofessional approach (eg, physicians and other health care professionals), with a focus on the contributions of PAs, NPs, and RNs.
Narrative review based on literature searches of the Medline database and treatment guidelines on the use of IT therapy in the management of patients with chronic pain.
The specific roles and responsibilities of PAs, NPs, and RNs in the management of patients receiving IT therapy vary by practice. In many pain treatment centers, PAs, NPs, and RNs are responsible for patient education, postimplant maintenance, and ongoing supportive care of patients receiving IT therapy. Topics that we address include patient selection, patient expectations and goal setting, medication selection, outcome assessment, and treatment adjustment. Currently, morphine and ziconotide (a nonopioid, selective N-type calcium channel blocker) are the only agents approved by the US Food and Drug Administration for IT analgesia. We provide relevant information on the dosing, titration, and adverse effect management of these medications for PAs, NPs, and RNs responsible for administering IT therapy.
PAs, NPs, and RNs are valuable members of IT pain management teams. Treatment success requires ongoing monitoring of efficacy and adverse effects, with corresponding adjustments to medication selection and dosing, in addition to good communication among the health care professionals involved in patient care.
医师助理（PAs）、执业护士（NPs）和注册护士（RNs）在疼痛管理团队中提供专业服务。本综述采用跨专业方法（如医生和其他医疗保健专业人员）概述了鞘内（IT）治疗慢性疼痛的实际管理，重点关注医师助理、执业护士和注册护士的贡献。
基于对Medline数据库的文献检索和IT治疗在慢性疼痛患者管理中应用的治疗指南进行叙述性综述。
医师助理、执业护士和注册护士在接受IT治疗患者管理中的具体角色和职责因实践而异。在许多疼痛治疗中心，医师助理、执业护士和注册护士负责接受IT治疗患者的患者教育、植入后维护和持续的支持性护理。我们讨论的主题包括患者选择、患者期望和目标设定、药物选择、结果评估和治疗调整。目前，吗啡和齐考诺肽（一种非阿片类、选择性N型钙通道阻滞剂）是美国食品药品监督管理局批准用于IT镇痛的仅有的药物。我们为负责实施IT治疗的医师助理、执业护士和注册护士提供有关这些药物给药、滴定和不良反应管理的相关信息。
医师助理、执业护士和注册护士是IT疼痛管理团队的重要成员。治疗成功需要持续监测疗效和不良反应，并相应调整药物选择和剂量，此外还需要参与患者护理的医疗保健专业人员之间进行良好的沟通。
