Cisewski David H, Motov Sergey M
Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine, New York, NY, USA.
Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, NY, USA.
Turk J Emerg Med. 2018 Dec 10;19(1):1-11. doi: 10.1016/j.tjem.2018.11.003. eCollection 2019 Jan.
Pain is the root cause for the overwhelming majority of emergency department (ED) visits worldwide. However, pain is often undertreated due to inappropriate analgesic dosing and ineffective utilization of available analgesics. It is essential for emergency providers to understand the analgesic armamentarium at their disposal and how it can be used safely and effectively to treat pain of every proportion within the emergency setting. A 'balanced analgesia' regimen may be used to treat pain while reducing the overall pharmacologic side effect profile of the combined analgesics. Channels-Enzymes-Receptors Targeted Analgesia (CERTA) is a multimodal analgesic strategy incorporating balanced analgesia by shifting from a system-based to a mechanistic-based approach to pain management that targets the physiologic pathways involved in pain signaling transmission. Targeting individual pain pathways allows for a variety of reduced-dose pharmacologic options - both opioid and non-opioid - to be used in a stepwise progression of analgesic strength as pain advances up the severity scale. By developing a familiarity with the various analgesic options at their disposal, emergency providers may formulate safe, effective, balanced analgesic combinations unique to each emergency pain presentation.
疼痛是全球绝大多数急诊就诊的根本原因。然而，由于镇痛剂量不当以及现有镇痛药使用效率低下，疼痛往往未得到充分治疗。急诊医护人员必须了解他们可使用的镇痛药种类，以及如何安全有效地使用这些药物来治疗急诊环境中各种程度的疼痛。“平衡镇痛”方案可用于治疗疼痛，同时降低联合使用镇痛药的总体药理学副作用。通道-酶-受体靶向镇痛（CERTA）是一种多模式镇痛策略，它通过从基于系统的方法转向基于机制的疼痛管理方法来纳入平衡镇痛，该方法针对疼痛信号传递所涉及的生理途径。针对个体疼痛途径允许使用多种低剂量药物选择——包括阿片类和非阿片类——随着疼痛严重程度的增加，以逐步增强的镇痛强度方式使用。通过熟悉他们可使用的各种镇痛选择，急诊医护人员可以针对每种急诊疼痛情况制定安全、有效、平衡的独特镇痛组合。
