Sohn David, Ring David, Toy Kristin A, Julian Justin A, Arnstein Paul
Instr Course Lect. 2019;68:639-646.
Opioid analgesics hijack the body's innate wellness machinery (eg, naloxone blocks the placebo effect) and alleviate both physical and emotional pain. Starting in the 1980s, marketing and advocacy created an opioid-centric pain relief strategy based on the idea that physicians undermanage pain and worry too much about addiction. The increase of prescription opioids in the ecosystem (along with a resurgence in heroin use) contributed to dependence, misuse, overdoses, and overdose deaths. Laws punishing undermanagement of pain from the opioid crisis combined with more recent laws punishing overprescription of opioids add to the difficulties orthopaedic surgeons have in managing the pain of surgery and acute injury. The substantial variation in pain intensity for nociception (actual or potential tissue damage) and the persistent use of opioids after healing is well established are both accounted for largely by psychosocial factors (stress, distress, and less effective coping strategies). When a patient has more pain than expected, surgeons should first rule out compartment syndrome and infection and then focus on a comprehensive team- and strategy-based approach that addresses these psychosocial factors.
阿片类镇痛药会劫持人体固有的健康机制（例如，纳洛酮会阻断安慰剂效应），并减轻身体和情感上的疼痛。从20世纪80年代开始，市场营销和宣传活动基于医生对疼痛处理不足且对成瘾过于担忧的观点，制定了以阿片类药物为中心的疼痛缓解策略。生态系统中处方阿片类药物的增加（以及海洛因使用的再度兴起）导致了药物依赖、滥用、过量用药及过量用药死亡。针对阿片类药物危机中疼痛处理不足的惩罚性法律，再加上近期针对阿片类药物过度处方的惩罚性法律，增加了骨科医生处理手术和急性损伤疼痛的难度。痛觉（实际的或潜在的组织损伤）的疼痛强度存在很大差异，且愈合后持续使用阿片类药物，这在很大程度上都由社会心理因素（压力、痛苦和效果较差的应对策略）导致。当患者疼痛比预期更严重时，外科医生应首先排除骨筋膜室综合征和感染，然后专注于基于团队和策略的综合方法，以解决这些社会心理因素。
