Ntalouka Maria P, Chatzis Athanasios, Nana Petroula, Spanos Konstantinos, Bareka Metaxia, Matsagkas Miltiadis, Arnaoutoglou Eleni
University of Thessaly Faculty of Medicine; Larissa University General Hospital, Department of Anaesthesiology, Larissa, Greece.
University of Thessaly Faculty of Medicine; Larissa University General Hospital, Department of Vascular Surgery, Larissa, Greece.
Turk J Anaesthesiol Reanim. 2024 Dec 16;52(6):200-206. doi: 10.4274/TJAR.2024.241657.
Peripheral artery disease (PAD) is quite prevalent, and its incidence will increase with aging of population. Pain is a key diagnostic feature of symptomatic PAD and has been linked to disease progression and poor quality of life. Symptom improvement is of utmost importance in PAD; therefore, optimal and comprehensive pain therapy is mandatory. However, the management of acute pain in PAD remains challenging due to the lack of high-quality evidence, the complex pathophysiological mechanisms of pain, and the high comorbidity of patients. On the other hand, inadequate pain control leads to several pathophysiological deviations, such as the aggravated neuroendocrine stress response, which may be detrimental in patients with PAD. Experts suggest that the management of acute pain in patients with vascular diseases should be oriented toward the underlying pathophysiological mechanisms of each modality and should follow a multifactorial approach. Although the exact pain pathways in PAD are still poorly understood and more probably multifactorial, they may be key to an effective, individualized, patient-centered, multimodal pain strategy. The aim of this review was to provide a holistic, beyond-opioids, individualized multimodal pain approach for patients with PAD.
外周动脉疾病（PAD）相当普遍，其发病率会随着人口老龄化而增加。疼痛是有症状PAD的关键诊断特征，并且与疾病进展和生活质量差有关。症状改善在PAD中至关重要；因此，最佳且全面的疼痛治疗是必不可少的。然而，由于缺乏高质量证据、疼痛复杂的病理生理机制以及患者的高合并症，PAD急性疼痛的管理仍然具有挑战性。另一方面，疼痛控制不足会导致多种病理生理偏差，如神经内分泌应激反应加重，这对PAD患者可能是有害的。专家建议，血管疾病患者急性疼痛的管理应针对每种方式的潜在病理生理机制，并应采用多因素方法。尽管PAD的确切疼痛途径仍知之甚少，且很可能是多因素的，但它们可能是有效、个体化、以患者为中心的多模式疼痛策略的关键。本综述的目的是为PAD患者提供一种全面的、超越阿片类药物的、个体化的多模式疼痛治疗方法。
