Mercadante Sebastiano, Coluzzi Flaminia
Anesthesia and Intensive Care Unit and Pain Relief and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
Pain Ther. 2021 Dec;10(2):765-775. doi: 10.1007/s40122-021-00272-x. Epub 2021 May 20.
Pain is a multidimensional experience that requires an appropriate assessment, and simple numbering may not be enough for the different components that are involved in the clinical expression. In consideration of the subjectivity of the symptom, each assessment should start from the way in which the patients perceive the pain and from how they deal with it. Some factors related to individual patient characteristics may make pain management difficult because of interference with the clinical pain expression. These factors may amplify the reporting of pain. Cognitive disorders and psychological distress seem to strongly influence pain expression and may render the analgesic treatment more difficult. Aberrant behaviors, such as alcoholism, smoking, and opioid misuse, may play a role, although geographic differences were found in terms of prevalence of the phenomenon, especially in some countries. Finally, the assessment of patients' expectation and the meaning of the personal feeling of changes in pain intensity provide new concepts in pain assessment, which may allow better personalization of the analgesic therapy. A modern pain assessment should include a multitude of factors influencing the phenotype of pain.
疼痛是一种多维度的体验，需要进行恰当评估，单纯的数字评分对于临床症状所涉及的不同组成部分可能并不足够。考虑到症状的主观性，每次评估都应从患者感知疼痛的方式以及他们应对疼痛的方式入手。一些与个体患者特征相关的因素可能会干扰临床疼痛表现，从而使疼痛管理变得困难。这些因素可能会加剧疼痛报告。认知障碍和心理困扰似乎会强烈影响疼痛表现，可能会使镇痛治疗更加困难。诸如酗酒、吸烟和阿片类药物滥用等异常行为可能也起到一定作用，尽管在该现象的患病率方面存在地域差异，尤其是在一些国家。最后，对患者期望以及疼痛强度变化的个人感受的意义进行评估，为疼痛评估提供了新的概念，这可能会使镇痛治疗的个性化程度更高。现代疼痛评估应涵盖众多影响疼痛表型的因素。
