Chronic pain and mental health: integrated solutions for global problems.
Chronic pain and mental health: integrated solutions for global problems.
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DOI：
10.1097/j.pain.0000000000001296
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发表时间：
2018-09
期刊：
影响因子：
7.4
通讯作者：
Patel V
中科院分区：
文献类型：
--
作者：
Kohrt BA;Griffith JL;Patel V
慢性疼痛是全球残疾生活年数的主要原因。低收入和中等收入国家的人口承受着不成比例的慢性疼痛负担，因为他们更容易受到道路伤害、人际和政治暴力、不受管制的体力劳动以及获得医疗保健的机会有限。全球精神卫生领域的经验教训可以为开始处理全球痛苦负担奠定基础。这些经验包括将一线社会心理护理的任务分担给非专业卫生工作者；跨诊断方法；使用纳入社会决定因素和合并症的综合征模型；结合有关痛苦的文化习语、疼痛的象征意义和传统的治疗方法；以及以人为本的方法，强调个人在家庭、环境和文化中的内在本质。这一证据对慢性疼痛管理的影响是多方面的，例如：将非专科、非医师卫生工作者提供的跨诊断心理社会干预作为第一步；基于慢性病管理良好实践原则的个性化医疗方法；同时解决与疼痛综合征相关的社会决定因素。综上所述，这些原则应用于设计干预平台，以解决慢性疼痛负担，同时降低全球阿片类药物过度使用的风险。
Chronic pain is the leading cause of years lived with disability globally. Populations in low- and middle-income countries bear a disproportionate burden of chronic pain because of greater exposure to road injuries, interpersonal and political violence, unregulated manual labor and limited access to healthcare. Lessons from the field of global mental health can provide a foundation to begin tackling the global burden of pain. These lessons include the use of task-sharing of front-line psychosocial care to non-specialized health workers; a transdiagnostic approach; use of syndemic models incorporating social determinants and co-morbidities; incorporating cultural idioms of distress, the symbolic meaning of pain, and traditional healing practices; and a person-centered approach emphasizing the embedded nature of an individual in her/his family, context and culture. The implications of this evidence for chronic pain management are manifold, for example: using transdiagnostic psychosocial interventions delivered by non-specialist, non-physician health workers as the first step; personalized medicine approaches based on good practice principles of chronic disease management; and concurrently addressing the social determinants often associated with pain syndromes. Taken together, these principles should be used to design intervention platforms that can address the burden of chronic pain, while reducing risks of over-utilization of opioid medications, globally.
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