Foreman P A, Harold P L, Hay K D
Oral Health Unit, Auckland Hospital.
N Z Dent J. 1994 Jun;90(400):44-8.
A review of the records and follow-up of 106 patients who had been referred to pain management clinics in Auckland between January 1990 and October 1992 because of chronic, protracted, orofacial pain, showed that more than half gained lasting benefit. This is consistent with the experience of other interdisciplinary pain clinics dealing with various chronic pain disorders, where previous and often multiple treatments have proved unsuccessful. The patients who made good progress tended to be those motivated to take charge of, and responsibility for, their own rehabilitation. Those patients still seeking a "cure", or who felt it was not up to them to take an active part in the management of their pain problem, tended to make poor or no progress. Of concern was the number of instances of misdiagnosis seen, resulting in inappropriate and, on occasion, harmful treatments. On average, the patients had consulted three general or specialist dental or medical practitioners before referral. Chronic pain problems usually require considerable time and a multidisciplinary environment for accurate diagnoses, and a carefully planned management programme. Often, neither are readily available to the busy general practitioner, whose training and experience is directed toward the treatment of acute pain. As a result, patients with chronic pain often end up treated with methods more appropriate for acute pain, which may entrench and compound the pain problem and lead to permanent disability. Recognition and referral of the patient with chronic pain at an early stage can improve the chances of successful management, and avoid frustration and disillusionment of both the practitioner and the patient.(ABSTRACT TRUNCATED AT 250 WORDS)
对1990年1月至1992年10月间因慢性、持续性口面部疼痛而被转诊至奥克兰疼痛管理诊所的106名患者的记录及随访情况进行回顾后发现，超过半数患者获得了持久的疗效。这与其他处理各种慢性疼痛疾病的多学科疼痛诊所的经验一致，在这些诊所中，先前往往是多次治疗均被证明无效。取得良好进展的患者往往是那些有动力负责自身康复并承担责任的人。那些仍在寻求“治愈”方法，或者认为积极参与疼痛问题管理并非自己责任的患者，往往进展不佳或毫无进展。令人担忧的是误诊情况的数量，这导致了不恰当甚至有时是有害的治疗。平均而言，患者在转诊前已咨询过三名普通或专科牙科或医学从业者。慢性疼痛问题通常需要大量时间以及多学科环境来进行准确诊断，并制定精心规划的管理方案。忙碌的普通医生往往既没有时间也没有这样的环境，他们的培训和经验主要针对急性疼痛的治疗。结果，慢性疼痛患者最终往往接受了更适合急性疼痛的治疗方法，这可能会使疼痛问题根深蒂固并加重，导致永久性残疾。早期识别并转诊慢性疼痛患者可以提高成功管理的几率，并避免从业者和患者双方的挫败感和幻灭感。（摘要截选至250词）
