Schnitzer T J
Office of Clinical Research and Training, Northwestern University, Chicago, Illinois 60611, USA.
Am J Med. 1998 Jul 27;105(1B):45S-52S. doi: 10.1016/s0002-9343(98)00073-4.
Chronic pain affects 75 million US citizens. A number of pharmacologic treatments are available for chronic pain that does not respond adequately to nonpharmacologic methods. Long the mainstay of chronic pain management, nonsteroidal anti-inflammatory drugs (NSAIDs) are known to be associated with gastrointestinal (GI) and renal toxicities, a particular problem for the elderly population, which commonly experiences chronic pain, such as that associated with osteoarthritis (OA). Several non-NSAID, non-narcotic therapies are available for noninflammatory pain. Acetaminophen is as effective as NSAIDs for the management of mild-to-moderate OA pain and is the recommended first-line therapy by the American College of Rheumatology (ACR). Propoxyphene, widely believed to be safe and effective, may, in fact, be no more effective-and perhaps less effective-than acetaminophen or ibuprofen. A relatively new analgesic, tramadol, appears to be a useful therapy for patients who do not receive adequate pain relief with acetaminophen and are at risk for NSAID-related side effects. For localized chronic pain associated with OA, topical capsaicin is also an effective analgesic.
慢性疼痛影响着7500万美国公民。对于对非药物方法反应不佳的慢性疼痛，有多种药物治疗可供选择。长期以来一直是慢性疼痛管理主要手段的非甾体抗炎药（NSAIDs），已知与胃肠道（GI）和肾脏毒性有关，这对通常患有慢性疼痛（如与骨关节炎（OA）相关的疼痛）的老年人群来说是个特别的问题。有几种非NSAID、非麻醉性疗法可用于治疗非炎性疼痛。对乙酰氨基酚在治疗轻至中度OA疼痛方面与NSAIDs效果相当，是美国风湿病学会（ACR）推荐的一线治疗药物。丙氧芬被广泛认为安全有效，但实际上可能并不比乙酰氨基酚或布洛芬更有效，甚至可能效果更差。一种相对较新的镇痛药曲马多，对于使用对乙酰氨基酚后疼痛缓解不充分且有NSAID相关副作用风险的患者似乎是一种有用的治疗方法。对于与OA相关的局部慢性疼痛，局部使用辣椒素也是一种有效的镇痛药。
