School of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
Curr Pain Headache Rep. 2024 Jun;28(6):525-534. doi: 10.1007/s11916-024-01249-z. Epub 2024 Apr 1.
Chronic pain affects a significant portion of the population globally, making it a leading cause of disability. Understanding the multifaceted nature of chronic pain, its various types, and the intricate relationship it shares with risk factors, comorbidities, and mental health issues like depression and anxiety is critical for comprehensive patient care. Factors such as socioeconomic status (SES), age, gender, and obesity collectively add layers of complexity to chronic pain experiences and pose management challenges.
Low SES presents barriers to effective pain care, while gender differences and the prevalence of chronic pain in aging adults emphasize the need for tailored approaches. The association between chronic pain and physical comorbidities like cardiovascular disease, chronic obstructive pulmonary disease (COPD), and diabetes mellitus reveals shared risk factors and further highlights the importance of integrated treatment strategies. Chronic pain and mental health are intricately linked through biochemical mechanisms, profoundly affecting overall quality of life. This review explores pharmacologic treatment for chronic pain, particularly opioid analgesia, with attention to the risk of substance misuse and the ongoing opioid epidemic. We discuss the potential role of medical cannabis as an alternative treatment with a nuanced perspective on its impact on opioid use. Addressing the totality and complexity of pain states is crucial to individualizing chronic pain management. With different types of pain having different underlying mechanisms, considerations should be made when approaching their treatment. Moreover, the synergistic relationship that pain states can have with other comorbidities further complicates chronic pain conditions.
慢性疼痛影响着全球很大一部分人群,是导致残疾的主要原因。了解慢性疼痛的多面性、其各种类型,以及它与风险因素、合并症和心理健康问题(如抑郁和焦虑)之间的复杂关系,对于全面的患者护理至关重要。社会经济地位(SES)、年龄、性别和肥胖等因素共同增加了慢性疼痛体验的复杂性,并带来了管理挑战。
低 SES 会对有效的疼痛护理造成障碍,而性别差异和老年人慢性疼痛的普遍存在强调了需要采用个性化方法。慢性疼痛与心血管疾病、慢性阻塞性肺疾病(COPD)和糖尿病等身体合并症之间的关联揭示了共同的风险因素,并进一步强调了综合治疗策略的重要性。慢性疼痛和心理健康通过生化机制紧密相连,深刻影响着整体生活质量。本综述探讨了慢性疼痛的药物治疗,特别是阿片类镇痛药,并关注了物质滥用的风险和持续存在的阿片类药物流行。我们讨论了医用大麻作为替代治疗的潜在作用,并对其对阿片类药物使用的影响进行了细致的分析。解决疼痛状态的整体和复杂性对于个体化慢性疼痛管理至关重要。不同类型的疼痛具有不同的潜在机制,因此在治疗时应考虑这些因素。此外,疼痛状态与其他合并症之间的协同关系进一步使慢性疼痛状况复杂化。