Veteran Affairs New England Mental Illness Research, Education and Clinical Center (MIRECC), West Haven, CT, USA; Advanced PACT Pain Clinic, VA Hampton Medical Center, 100 Emancipation Drive, PRIME 5, Hampton, VA 23667, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
Opioid Reassessment Clinic, VA Connecticut Healthcare System, 950 Campbell Avenue, Mailstop 151B, West Haven, CT 06516, USA; Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, West Haven, CT, USA; Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
Med Clin North Am. 2018 Jul;102(4):745-763. doi: 10.1016/j.mcna.2018.02.013.
The current opioid crisis highlights an urgent need for better paradigms for prevention and treatment of chronic pain and addiction. Although many approach this complex clinical condition with the question, "Is this pain or is this addiction?," it is more than the sum of its parts. Chronic pain among those with dependence and addiction often evolves into a complex disabling condition with pain at multiple sites, psychosocial dysfunctions, medical and psychiatric disorders, polypharmacy, and polysubstance use, all interacting with each other in complex ways (multimorbidity). The authors offer an integrative therapeutic approach to manage this complex clinical scenario.
当前的阿片类药物危机凸显出迫切需要更好的模式来预防和治疗慢性疼痛和成瘾。尽管许多人在面对这种复杂的临床情况时会问，“这是疼痛还是成瘾？”，但这不仅仅是其各个部分的总和。依赖和成瘾人群中的慢性疼痛常常演变成一种复杂的致残疾病，多个部位疼痛、心理社会功能障碍、医学和精神障碍、多药治疗和多物质使用，所有这些都以复杂的方式相互作用（多种疾病）。作者提供了一种综合治疗方法来管理这种复杂的临床情况。
