Department of Anaesthesiology, Critical Care Medicine, Pain Therapy and Palliative Care, Benedictus Hospital Feldafing, Feldafing, Germany.
Department of Anaesthesiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
Curr Med Res Opin. 2020 Dec;36(12):2037-2046. doi: 10.1080/03007995.2020.1832058. Epub 2020 Oct 21.
The term "mixed pain" is increasingly applied for specific clinical scenarios, such as low back pain, cancer pain and postsurgical pain, in which there "is a complex overlap of the different known pain types (nociceptive, neuropathic, nociplastic) in any combination, acting simultaneously and/or concurrently to cause pain in the same body area." Whether mixed pain is the manifestation of neuropathic and nociceptive mechanisms operating simultaneously or concurrently, or the result of an entirely independent pathophysiological mechanism - distinct from nociceptive, nociplastic and neuropathic pain - is currently unknown. At present, the diagnosis of mixed pain is made based on clinical judgement following detailed history-taking and thorough physical examination, rather than by formal confirmation following explicit screening or diagnostic criteria; this lack of formalized screening or diagnostic tools for mixed pain is problematic for physicians in primary care, who encounter patients with probable mixed pain states in their daily practice. This article outlines a methodical approach to clinical evaluation of patients presenting with acute, subacute or chronic pain, and to possibly identifying those who have mixed pain. The authors propose the use of nine simple key questions, which will provide the practicing clinician a framework for identifying the predominant pain mechanisms operating within the patient. A methodical, fairly rapid, and comprehensive assessment of a patient in chronic pain - particularly one suffering from pain with both nociceptive and neuropathic components - allows validation of their experience of chronic pain as a specific disease and, importantly, allows the institution of targeted treatment.
“混合痛”这一术语越来越多地用于特定的临床情况，如腰痛、癌痛和术后痛，在这些情况下，“不同已知的疼痛类型（伤害性、神经性、病理性）以任何组合形式复杂地重叠，同时或同时作用，导致同一身体区域的疼痛。” 目前尚不清楚混合痛是神经性和伤害性机制同时或同时作用的表现，还是一种与伤害性、病理性和神经性疼痛完全不同的独立病理生理机制的结果。目前，混合痛的诊断是基于详细的病史询问和彻底的体格检查后的临床判断，而不是通过明确的筛查或诊断标准进行正式确认；目前缺乏针对混合痛的规范化筛查或诊断工具，这对初级保健医生来说是个问题，因为他们在日常实践中会遇到可能患有混合痛状态的患者。本文概述了一种对出现急性、亚急性或慢性疼痛的患者进行临床评估并可能确定其是否患有混合痛的方法。作者提出使用九个简单的关键问题，这将为执业临床医生提供一个框架，以确定患者体内主要的疼痛机制。对慢性疼痛患者（特别是那些同时存在伤害性和神经性疼痛的患者）进行系统、相当快速和全面的评估，可以验证他们对慢性疼痛作为一种特定疾病的体验，重要的是，可以进行有针对性的治疗。
