回首往事,疼痛医学向前迈进。
Looking Back, Moving Forward in Pain Medicine.
作者信息
Paladini Antonella, Gharibo Christopher, Khalbous Sonia, Salti Ammar, Ergönenç Tolga, Pasqualucci Alberto, Varrassi Giustino
机构信息
Life, Health, and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA.
Pain Management, New York University (NYU) Langone Health, New York City, USA.
出版信息
Cureus. 2023 Sep 5;15(9):e44716. doi: 10.7759/cureus.44716. eCollection 2023 Sep.
Pain is an ancient medical complaint and a clinical riddle that has never been entirely solved. Looking back into history was the springboard to a look into the future of pain medicine. This article was based on a series of presentations given in a recent congress (May 2023) and represents the research, views, and opinions of the authors. Opium has been used for millennia to treat pain, but when it gained broad use in the United States in the 1980s and 1990s, it was so vastly overprescribed and mis-prescribed that it led to a public health crisis. This, in turn, led to the reaction where opioids at times were under-prescribed, leaving out many patients who may have benefited from opioids while leaving many legacy pain patients to manage withdrawal on their own and with few analgesic options. Cannabinoids (CB) were likewise widely used for various conditions, including pain, but were outlawed in the 20th century, only to be brought back as a potential analgesic agent. Interventional pain medicine is a developing discipline and has reinforced the concept of the interdisciplinary pain clinic. It plays an increasingly important part in modern medicine overall, especially with the support of ultrasound, for both diagnosis and therapy. Today, the views about pain have changed. Anyone has accepted that pain is not purely a physical phenomenon but a biopsychosocial phenomenon that occurs within a cultural context. Pain management remains a small but vitally important medical subspecialty that is critical from a functional enablement and population health perspective, which is helping to navigate new therapeutic targets, new drugs and routes of administration, greater understanding of pain psychology, and new technologies. Pain control today means early intervention, functional enablement through pain alleviation, educating patients about pain management, and minimizing the transition from acute to chronic pain.
疼痛是一种古老的医学病症,也是一个从未被完全解开的临床谜题。回顾历史是展望疼痛医学未来的跳板。本文基于近期一次大会(2023年5月)上的一系列演讲,代表了作者们的研究、观点和意见。鸦片已被使用了数千年以治疗疼痛,但在20世纪80年代和90年代在美国广泛使用时,它被过度处方和错误处方到如此程度,以至于引发了一场公共卫生危机。这反过来又导致了一种反应,即阿片类药物有时处方不足,使许多可能从阿片类药物中受益的患者被遗漏,同时让许多长期疼痛患者自行应对戒断反应且几乎没有止痛选择。大麻素同样被广泛用于各种病症,包括疼痛,但在20世纪被列为非法,后来又作为一种潜在的止痛剂卷土重来。介入性疼痛医学是一门发展中的学科,强化了跨学科疼痛诊所的概念。它在现代医学整体中发挥着越来越重要的作用,尤其是在超声的支持下,用于诊断和治疗。如今,关于疼痛的观点已经改变。任何人都已接受疼痛并非纯粹的生理现象,而是一种在文化背景中发生的生物心理社会现象。疼痛管理仍然是一个规模虽小但至关重要的医学亚专业,从功能实现和人群健康的角度来看至关重要,它有助于探寻新的治疗靶点、新药和给药途径,加深对疼痛心理学的理解以及采用新技术。如今的疼痛控制意味着早期干预、通过减轻疼痛实现功能实现、对患者进行疼痛管理教育以及尽量减少从急性疼痛向慢性疼痛的转变。