Carpenter Christopher R, Lewis Lawrence, Jotte Randall S, Schwarz Evan S
Christopher R. Carpenter, MD, MSc, MSMA member since 2016, Associate Professor, is in the Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Mo.
Lawrence Lewis, MD, Professor, is in the Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Mo.
Mo Med. 2018 May-Jun;115(3):241-246.
Opioid misuse is reducing Americans' life expectancy, thereby catalyzing professional societies and legislators to action. Efforts to combat the opioid epidemic must work hand-in-hand with appropriate efforts to reduce the severity and duration of suffering. Pharmacologic analgesia is temporizing. Current opioid prescribing guidelines focus on reducing the frequency and quantity of narcotics prescribed, but lack attention to alleviation of the source of pain. Conditions eliciting acute pain sometimes require additional specialist management following discharge from the emergency department. Patients frequently lack timely access to these specialists, particularly if underinsured. This essay explores acute dental pain, extremity fractures, and back pain as three common examples whereby complex healthcare systems must efficiently adapt in order to serve the dual objectives of reducing the risk of opioid-related adverse consequences and minimizing the duration of patient suffering.
阿片类药物的滥用正在降低美国人的预期寿命,从而促使专业协会和立法者采取行动。抗击阿片类药物流行的努力必须与减轻痛苦的严重程度和持续时间的适当努力携手并进。药物镇痛只是权宜之计。当前的阿片类药物处方指南侧重于减少开具的麻醉药品的频率和数量,但忽视了缓解疼痛根源。引发急性疼痛的病症有时在从急诊科出院后需要额外的专科治疗。患者常常无法及时获得这些专科治疗,尤其是在保险不足的情况下。本文探讨急性牙痛、四肢骨折和背痛这三个常见例子,复杂的医疗系统必须有效适应这些例子,以实现降低阿片类药物相关不良后果风险和尽量缩短患者痛苦持续时间这两个双重目标。