THE ASSESSMENT AND TREATMENT OF PAIN IN THE EMERGENCY ROOM
THE ASSESSMENT AND TREATMENT OF PAIN IN THE EMERGENCY ROOM
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DOI：
10.1097/00002508-198906002-00004
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发表时间：
1989-01-01
影响因子：
2.9
通讯作者：
BOISAUBIN, EV
中科院分区：
文献类型：
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作者：
BOISAUBIN, EV
现代急救中心（EC）面临着各种各样的痛苦状况。三种最常见的类别是急性自限性疾病;慢性内科或外科综合征急性加重;和精神疼痛综合征，其中病因不容易确定。许多因素可以区分疼痛和痛苦，医生不仅应该教育患者了解病情的性质和预后，而且还应该了解预期的不适。EC的临床问题包括医生倾向于治疗不足甚至忽视疼痛，需要适当但灵活的剂量计划，以及医生对掩盖重要体征和症状的担忧。非甾体抗炎药（NSAIDs）是目前最安全、最有效的口服镇痛药。药物选择的重要因素包括疗效、剂量、无副作用和成本。有两类特殊的病人，即精神疼痛综合征病人和有寻求药物行为的病人，会给医生带来麻烦。慢性疼痛综合征患者需要特殊随访，但不能从额外的镇痛药物治疗中获益。寻求和滥用药物的患者可能难以识别，可能有真正的潜在医学病理学，不应给予麻醉处方。
A broad spectrum of painful conditions presents to the modern emergency center (EC). The three most common categories are acute, self-limited disorders; chronic medical or surgical syndromes with acute exacerbation; and psychic pain syndromes in which the etiology cannot be easily ascertained. Many factors may differentiate pain from suffering, and physicians should educate patients not only about the nature of their condition and its prognosis, but also about anticipated discomfort. Clinical concerns in the EC include physicians' tendency to undertreat or even ignore pain, the need for appropriate but flexible dosage schedules, and physicians' concern about masking important signs and symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are currently the safest and most effective group of oral analgesics. Important factors for drug selection include efficacy, dosage, lack of side effects, and cost. Two special groups of patients, those with psychic pain syndromes and those with drug-seeking behavior, can create problems for the physician. Patients with chronic pain syndromes need special follow-up but do not benefit from additional analgesic drug therapy. Patients who seek and abuse drugs can be difficult to identify, may have true underlying medical pathology, and should not be given narcotic prescriptions.