Katz W A
Division of Rheumatology, University of Pennsylvania Health System, Presbyterian Medical Center, Philadelphia 19104, USA.
Am J Med. 1998 Jul 27;105(1B):2S-7S. doi: 10.1016/s0002-9343(98)00068-0.
Pain affects everyone at some point in their life. However, everyone experiences pain in a highly individualized way, and therefore, the management of pain must also be customized. Of the 3 general types of pain-acute, chronic malignant, and chronic nonmalignant-the latter is the least predictable and, therefore, can be the most difficult to treat. General principles of pain management can be summarized as (1) respecting the pain and the patient; (2) recognizing and addressing the psychosocial aspects of pain; and (3) treating the pain-and the underlying cause-appropriately and in a timely fashion. The best success in pain management relies on a multidisciplinary approach that includes patient education, medications, physical medicine, and psychological counseling. Although a number of effective analgesic drugs are available, all are associated with adverse events. To reduce the risk of these side effects, the patient's specific needs and medical history must be considered before initiating therapy. Central to effective management of chronic pain is a positive physician-patient relationship. Several strategies are discussed to help in building such a connection.
疼痛在每个人生命中的某个阶段都会出现。然而，每个人体验疼痛的方式都高度个体化，因此，疼痛管理也必须因人而异。在急性疼痛、慢性恶性疼痛和慢性非恶性疼痛这三种常见疼痛类型中，后者最难以预测，因此也可能是最难治疗的。疼痛管理的一般原则可概括为：（1）尊重疼痛和患者；（2）认识并处理疼痛的社会心理因素；（3）及时且恰当地治疗疼痛及其潜在病因。疼痛管理的最大成功依赖于多学科方法，包括患者教育、药物治疗、物理治疗和心理咨询。尽管有多种有效的镇痛药，但所有这些药物都有不良反应。为降低这些副作用的风险，在开始治疗前必须考虑患者的具体需求和病史。医患之间积极的关系是有效管理慢性疼痛的核心。本文讨论了几种有助于建立这种关系的策略。
