Department of Physical Therapy and Rehabilitation, Drexel University, 1601 Cherry Street, Room 758, MS 7-502, Philadelphia, PA 19102 (USA). Dr Wenger is a board-certified orthopaedic clinical specialist.
Department of Physical Therapy and Rehabilitation, Drexel University.
Phys Ther. 2018 May 1;98(5):424-433. doi: 10.1093/ptj/pzy025.
The implementation of recent Centers for Disease Control and Prevention recommendations to move away from opioids and toward nonpharmacological therapies for the treatment of chronic pain could involve a difficult transition period for patients and practitioners. The focus of treatment should shift from eliminating pain completely to minimizing the impact of pain on quality of life. Many patients with chronic pain take opioids either because opioids were previously prescribed as a first-line treatment for chronic pain, on the basis of old standards of care, or because opioids were initially prescribed for acute pain. Patients currently taking opioids will need a tapering period during which they transition their pain management to interdisciplinary care and nonpharmacological treatments. To provide useful treatment options, physical therapists need to have a good understanding of the neuroscientific mechanisms of chronic pain, biopsychosocial components of chronic pain management, issues related to opioid use, and pain management strategies used by other health care professionals. Armed with knowledge and good communication skills, physical therapists can work within an interdisciplinary team to adapt care to each patient's needs and abilities. This perspective article provides guidance for physical therapists to effectively treat patients with chronic pain during the opioid tapering process. A framework has been created to help health care providers structure their reasoning as they collaborate to develop a unique approach for each patient.
最近疾病控制与预防中心建议停止使用阿片类药物，转而采用非药物疗法治疗慢性疼痛，这可能会给患者和医生带来一段艰难的过渡期。治疗的重点应从完全消除疼痛转移到将疼痛对生活质量的影响降至最低。许多慢性疼痛患者服用阿片类药物，要么是因为根据旧的护理标准，阿片类药物曾被开为慢性疼痛的一线治疗药物，要么是因为阿片类药物最初是为急性疼痛开的。目前正在服用阿片类药物的患者需要一个逐渐减少剂量的过程，在此期间，他们将疼痛管理过渡到跨学科护理和非药物治疗。为了提供有用的治疗选择，物理治疗师需要很好地了解慢性疼痛的神经科学机制、慢性疼痛管理的生物心理社会组成部分、与阿片类药物使用相关的问题以及其他医疗保健专业人员使用的疼痛管理策略。物理治疗师可以利用知识和良好的沟通技巧，在跨学科团队中工作，根据每个患者的需求和能力调整护理。本文为物理治疗师在阿片类药物逐渐减少的过程中有效治疗慢性疼痛患者提供了指导。已经创建了一个框架，帮助医疗保健提供者在协作制定每个患者独特方法时构建他们的推理。
