Davies H T, Crombie I K, Macrae W A
Department of Epidemiology and Public Health, Dundee University, Scotland, UK.
J R Soc Med. 1994 Jul;87(7):382-5. doi: 10.1177/014107689408700704.
Pain arising from damage or malfunction of the nervous system (for example postherpetic neuralgia, peripheral nerve injuries and the neuropathies) is often severe and resistant to standard analgesics. These patients are commonly seen in pain clinics where they receive a variety of treatments including psychotropic drugs (such as antidepressants and anticonvulsants), nerve blocks and stimulation. There is concern that the management of these difficult patients may be less than optimal where they are not seen by pain specialists. We examined a cohort of 703 patients with long-established nerve-damage pain seen in ten outpatient pain clinics. We compared their use of treatments prior to referral with the management given in the pain clinic. The majority of patients (79%) had had their pain for over 1 year before being seen in the pain clinic, yet many had not tried simple and effective treatments prior to referral. Less than a quarter had received an adequate trial of antidepressants; only one in seven had been appropriately treated with anticonvulsants; and only one in 10 had tried a nerve stimulator. All these treatments were frequently provided in the pain clinic. Referral of patients with nerve-damage pain to a pain clinic may greatly increase their access to therapies of proven value.
由神经系统损伤或功能障碍引起的疼痛（例如带状疱疹后神经痛、周围神经损伤和神经病变）通常很严重，且对标准镇痛药有抗性。这些患者在疼痛门诊很常见，在那里他们会接受包括精神药物（如抗抑郁药和抗惊厥药）、神经阻滞和刺激在内的各种治疗。有人担心，在没有疼痛专科医生诊治的情况下，对这些难治性患者的管理可能不够理想。我们对在十家门诊疼痛诊所就诊的703例患有长期神经损伤性疼痛的患者进行了研究。我们比较了他们转诊前的治疗使用情况与疼痛诊所给予的治疗管理。大多数患者（79%）在到疼痛诊所就诊前疼痛已超过1年，但许多患者在转诊前并未尝试过简单有效的治疗方法。不到四分之一的患者接受过充分的抗抑郁药试验；只有七分之一的患者接受过适当的抗惊厥药治疗；只有十分之一的患者尝试过神经刺激器。所有这些治疗方法在疼痛诊所都经常提供。将神经损伤性疼痛患者转诊至疼痛诊所可能会大大增加他们获得经证实有效的治疗方法的机会。
