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慢性疼痛的治疗概述

Author
Ellen WK Rosenquist, MD
Section Editor
Mark D Aronson, MD
Deputy Editor
Lee Park, MD, MPH
Translators
于灵芝, 主任医师，教授

引言

慢性疼痛是人们寻求医疗救治最常见的原因之一，20%-50%初级保健就诊的患者报告存在慢性疼痛[1,2]。目前有许多药物和非药物治疗可用于慢性疼痛患者。本专题将概述这些疗法。 慢性疼痛的发病机制和评估将单独讨论。 (参见“慢性疼痛的定义及发病机制”和“成人慢性疼痛的评估”)

治疗患者的方法

慢性疼痛的治疗选择通常分为6大类：药物方法、物理医学方法、行为医学方法、神经调节方法、介入方法和外科方法。最佳的患者结局通常是在一个多学科团队的协同下，联合使用多种方法实现的[3]。初级保健中的协作医疗模式可改善疼痛治疗和患者结局[4,5]。治疗不应只专注于使用药物，而是在需要时使用，并联合其他治疗方法，以达到治疗目标[6]。

对慢性疼痛的患者需进行持续的评估、教育和安慰，并帮助他们建立对疗效合理的预期。 目前可用的治疗方法平均只能使疼痛减少约30%[7]。但即使是30%的部分缓解也可具有临床意义，可改善患者的生存质量[8]。

可选择的药物

药物治疗方法是使用最广泛的缓解持续性疼痛的治疗选择。疼痛治疗药物的主要类别包括：非阿片类镇痛药、阿片类镇痛药和辅助药物(用于治疗与疼痛药物有关的副作用或加强镇痛作用)：

●非阿片类镇痛药：如阿司匹林、对乙酰氨基酚、非甾体类抗炎药(nonsteroidal anti-inflammatory drug, NSAID)、环氧合酶-2(cyclooxygenase 2, COX-2)抑制剂

                                                             

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-17.
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