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肌肉骨骼疾病:疼痛和残疾的普遍根源,被误解和管理不善——基于美国护理模式的批判性分析

Musculoskeletal Disorders a Universal Source of Pain and Disability Misunderstood and Mismanaged: A Critical Analysis Based on the U.S. Model of Care.

作者信息

Malik Khalid M, Beckerly Rena, Imani Farnad

机构信息

University of Illinois, Chicago, United States.

Pain Research Center, Iran University of Medical Sciences, Tehran, Iran.

出版信息

Anesth Pain Med. 2018 Dec 15;8(6):e85532. doi: 10.5812/aapm.85532. eCollection 2018 Dec.

Abstract

Musculoskeletal disorders are the leading source of pain and disability globally but are especially prevalent in the industrialized nations including the U.S. In addition to the substantial individual suffering caused the rising monetary costs of these disorders are noteworthy. In the U.S. alone the annual costs have been estimated to be $874 billion 5.7% of the annual U.S. G.D.P. Despite these expenditures the care provided to patients with musculoskeletal disorders is highly variable and has regularly been shown to have suboptimal outcomes. The many reasons for this ineffective care include the mutable nature of the prevailing syndromes and their limited and variable understanding. The care rendered by a broad and incongruent group of providers who practice disparate methodologies and employ variable treatments. Disorderedly triage comprised of arbitrary selection of providers, care methodologies, and treatments, which is prone to a range of extraneous influences. Treatments that are unable to apprehend the causative pathological processes, which are therefore progressive, cause irreversible damage to the respective musculoskeletal structures, and result in enduring pain and disability. The overall lack of preventative care and the consequent prevalence of these disorders especially in specific work environments and with certain high-risk life styles. This article makes recommendations for better understanding, prevention, early recognition, timely employment of disease altering therapies, streamlining the existing care, and policy initiatives for waste confinement and improvement. These discernments may improve the overall quality of care provided to these patients, diminish the staggering pain and disability caused, and can reduce the immense costs incurred.

摘要

肌肉骨骼疾病是全球疼痛和残疾的主要原因,在包括美国在内的工业化国家尤为普遍。除了造成巨大的个人痛苦外,这些疾病不断上升的金钱成本也值得关注。仅在美国,每年的成本估计就高达8740亿美元,占美国年度国内生产总值的5.7%。尽管有这些支出,但为肌肉骨骼疾病患者提供的护理差异很大,而且经常被证明效果欠佳。这种无效护理的原因有很多,包括普遍存在的综合征的易变性质以及对它们的理解有限且多变。由广泛且不一致的医疗服务提供者群体提供的护理,他们采用不同的方法并使用不同的治疗手段。无序分诊,包括随意选择医疗服务提供者、护理方法和治疗手段,容易受到一系列外部影响。无法理解致病病理过程的治疗方法,因此这些疾病会不断发展,对相应的肌肉骨骼结构造成不可逆转的损害,并导致持久的疼痛和残疾。整体缺乏预防护理,以及这些疾病的普遍存在,尤其是在特定的工作环境和某些高风险生活方式中。本文就更好地理解、预防、早期识别、及时采用改变疾病的疗法、简化现有护理以及限制浪费和改进的政策举措提出了建议。这些见解可能会提高为这些患者提供的整体护理质量,减轻所造成的惊人疼痛和残疾,并降低所产生的巨大成本。

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