Managing pain in high-risk patients within a patient-centered medical home
Managing pain in high-risk patients within a patient-centered medical home
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DOI：
10.1007/s13142-012-0113-z
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发表时间：
2012-03-01
影响因子：
3.6
通讯作者：
McLellan, A. Thomas
中科院分区：
文献类型：
--
作者：
Cheatle, Martin D.;Klocek, John W.;McLellan, A. Thomas
尽管在诊断、药物治疗以及侵入性和非侵入性干预方面取得了显著进展，但慢性疼痛仍然是一个主要的医疗保健问题。美国慢性疼痛的患病率令人震惊，并持续增长，个人和社会成本并非微不足道。疼痛的病因是复杂的，并且患有慢性疼痛的个体倾向于具有显著的医学和精神共病，例如抑郁症、焦虑症，并且在某些情况下，物质使用障碍。对于非医疗用途和接受慢性阿片类药物治疗的疼痛患者中处方阿片类药物误用/滥用的迅速增长，人们深感关切。虽然关于疼痛人群中阿片类药物滥用的“真实”发生率仍在争论，但显然，患有疼痛和物质使用障碍的患者具有特殊性挑战性。大多数慢性疼痛患者，包括那些同时发生的物质使用障碍的患者，都是在初级保健环境中进行管理的。初级保健从业人员没有足够的时间、资源和培训来有效地评估、治疗和监测这些复杂的病例。已经制定了一些关于阿片类药物治疗和风险缓解的循证和专家共识治疗指南，但它们在专科和初级保健诊所都没有得到充分利用。本文将讨论利用新技术和递送系统对接受阿片类药物治疗的疼痛患者进行风险分层、干预和监测。
Chronic pain remains a major healthcare problem despite noteworthy advancements in diagnostics, pharmacotherapy, and invasive and non-invasive interventions. The prevalence of chronic pain in the United States is staggering and continues to grow, and the personal and societal costs are not inconsequential. The etiology of pain is complex, and individuals suffering from chronic pain tend to have significant medical and psychiatric comorbidities such as depression, anxiety, and in some cases, substance use disorders. There is great concern regarding the burgeoning rate of prescription opioid misuse/abuse both for non-medical use and in pain patients receiving chronic opioid therapy. While there is ongoing debate about the "true" incidence of opioid abuse in the pain population, clearly, patients afflicted with both pain and substance use disorder are particularity challenging. The majority of patients with chronic pain including those with co-occurring substance use disorders are managed in the primary care setting. Primary care practitioners have scant time, resources and training to effectively assess, treat and monitor these complicated cases. A number of evidence-and expert consensus-based treatment guidelines on opioid therapy and risk mitigation have been developed but they have been underutilized in both specialty and primary care clinics. This article will discuss the utilization of new technologies and delivery systems for risk stratification, intervention and monitoring of patients with pain receiving opioid.