Department of Psychiatry, George Washington University, Washington, DC, United States.
The Pershing Square Professor of Global Health, Harvard Medical School, Boston, MA, United States.
Pain. 2018 Sep;159 Suppl 1(Suppl 1):S85-S90. doi: 10.1097/j.pain.0000000000001296.
Chronic pain is the leading cause of years lived with disability globally. Populations in low- and middle-income countries bear a disproportionate burden of chronic pain because of greater exposure to road injuries, interpersonal and political violence, unregulated manual labor and limited access to healthcare. Lessons from the field of global mental health can provide a foundation to begin tackling the global burden of pain. These lessons include the use of task-sharing of front-line psychosocial care to non-specialized health workers; a transdiagnostic approach; use of syndemic models incorporating social determinants and co-morbidities; incorporating cultural idioms of distress, the symbolic meaning of pain, and traditional healing practices; and a person-centered approach emphasizing the embedded nature of an individual in her/his family, context and culture. The implications of this evidence for chronic pain management are manifold, for example: using transdiagnostic psychosocial interventions delivered by non-specialist, non-physician health workers as the first step; personalized medicine approaches based on good practice principles of chronic disease management; and concurrently addressing the social determinants often associated with pain syndromes. Taken together, these principles should be used to design intervention platforms that can address the burden of chronic pain, while reducing risks of over-utilization of opioid medications, globally.
慢性疼痛是全球导致残疾年数的主要原因。由于更多地接触道路伤害、人际和政治暴力、不受监管的体力劳动以及有限的医疗保健机会，中低收入国家的民众承受着不成比例的慢性疼痛负担。全球心理健康领域的经验教训可以为开始解决全球疼痛负担提供基础。这些经验教训包括将一线心理社会保健工作任务分担给非专业卫生工作者；采用跨诊断方法；使用包含社会决定因素和合并症的综合征模型；纳入痛苦的文化习语、疼痛的象征意义和传统的治疗方法；以及以个人为中心的方法，强调个体在其家庭、背景和文化中的内在本质。这些证据对慢性疼痛管理的影响是多方面的，例如：使用非专业、非医生卫生工作者提供的跨诊断心理社会干预作为第一步；基于慢性病管理良好实践原则的个体化药物治疗方法；以及同时解决与疼痛综合征相关的社会决定因素。总的来说，这些原则应被用来设计干预平台，以减轻全球范围内慢性疼痛的负担，同时降低过度使用阿片类药物的风险。
