疼痛:无声的公共健康流行病。
Pain: The Silent Public Health Epidemic.
机构信息
University of New Mexico School of Medicine, Albuquerque, NM, USA.
Department of Neurosurgery, University of New Mexico, Albuquerque, USA.
出版信息
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241253547. doi: 10.1177/21501319241253547.
More than 50 million Americans suffer from chronic pain, costing our society an estimated 565 to 635 billion dollars annually. Its complexity and training deficits in healthcare providers result in many patients receiving ineffective care. Large health inequities also exist in access to effective pain care for vulnerable populations. The traumatic history of indigenous people and people of color in regards to the experience of pain care perpetuates a lack of trust in the healthcare system, causing many to hesitate to seek medical treatment for painful events and conditions. Other vulnerable populations include those with sickle cell disease or fibromyalgia, whose experience of pain has not been well-understood. There are both barriers to care and stigma for patients with pain, including those taking prescribed doses of long-term opioids, those with known substance use disorder, and those with mental health diagnoses. The suffering of patients with pain can be "invisible" to the clinician, and to one's community at large. Pain can affect all people; but those most vulnerable to not getting effective care may continue to suffer in silence because their voices are not heard. Since 1973, pain societies around the globe have worked tirelessly to bring clinicians together to advance pain and opioid education, research, and patient care. These improvements consist of pain education, integrative treatment, and the understanding that a therapeutic alliance is critical to effective pain management. Pain education for both pre and post-licensure health professionals has increased substantially over the last decade. In addition, integrative and interdisciplinary approaches for clinical pain management are now considered best practices in pain care for patients with moderate to severe pain in addition to the development of a strong therapeutic alliance.
超过 5000 万美国人患有慢性疼痛,每年给我们的社会造成约 5650 亿至 6350 亿美元的损失。由于医疗保健提供者在复杂性和培训方面的不足,导致许多患者接受的治疗效果不佳。在获得有效疼痛护理方面,弱势群体也存在较大的健康不平等。在疼痛护理方面,原住民和有色人种的创伤历史导致他们对医疗体系缺乏信任,许多人在出现疼痛事件和疾病时犹豫不决,不愿寻求医疗治疗。其他弱势群体包括患有镰状细胞病或纤维肌痛的人,他们的疼痛体验尚未得到充分理解。疼痛患者既存在治疗障碍,也面临污名化,包括那些服用规定剂量的长期阿片类药物的患者、已知有物质使用障碍的患者和有精神健康诊断的患者。疼痛患者的痛苦可能对临床医生和整个社区来说是“无形”的。疼痛可能影响所有人;但那些最容易得不到有效治疗的人可能会继续默默承受痛苦,因为他们的声音没有被听到。自 1973 年以来,全球各地的疼痛协会一直不懈努力,将临床医生聚集在一起,以推进疼痛和阿片类药物教育、研究和患者护理。这些改进包括疼痛教育、综合治疗以及认识到治疗联盟对有效疼痛管理至关重要。过去十年,对预许可和许可后卫生专业人员的疼痛教育有了大幅增加。此外,除了建立强大的治疗联盟外,对于中度至重度疼痛患者的临床疼痛管理,综合和跨学科方法现在也被认为是最佳实践。