慢性疼痛的綜合管理

承認(rèn)慢性疼痛本身就是一種診斷(ICD-11中已經(jīng)引入慢性原發(fā)性疼痛),可以幫助臨床醫(yī)師和患者從尋找診斷的心態(tài)轉(zhuǎn)向討論長(zhǎng)期管理策略[5]。部分慢性疼原因不成比例，常規(guī)CT或MRI檢查能獲得的診斷信息有限[11]。診斷性治療(區(qū)域阻滯治療)是一種可用于部分診斷不明的慢性疼痛的診斷方法。2018年世界衛(wèi)生組織發(fā)布的ICD-11中第一次提出了慢性疼痛系統(tǒng)診斷分類(lèi)[8],有助于收集全面的流行病學(xué)數(shù)據(jù)，區(qū)分慢性術(shù)用于慢性疼痛診斷，有助于提高慢性疼痛的診斷2多維度評(píng)估疼痛Baker面部表情疼痛評(píng)分量表等單維度疼痛評(píng)估量表僅能對(duì)疼痛強(qiáng)度進(jìn)行評(píng)估，疼社會(huì)因素。慢性疼痛存在感覺(jué)、情緒、認(rèn)知和行為4個(gè)維度，推薦疼痛進(jìn)行評(píng)估。簡(jiǎn)化的McGill疼痛問(wèn)卷表2(Shot-formMcgillPainQuestionnaire ,SF-MPQ2)能夠?qū)μ弁葱再|(zhì)、疼痛強(qiáng)1.7基因(使用dCas9蛋白實(shí)現(xiàn)對(duì)NaV1.7的非永久性基因抑制或使用ZFP鋅指蛋白進(jìn)行表rtheStudyofPaindefinitionofpain:concepts,challenges,andcompromises[J].Pain,2020,161(9):1976-1982.DOI:10.1097/j.pain.0000000000001939[2]TreedeRD,RiefWfDiseases(ICD11)[J].Pain,2019,16雜志，2016,18(4):481-486.DOI:10.3760/cma.j.issn.1008-1372.2016.04.001.[4]CohenSP,VaseL,HootenWM.Chronicpain:anupdateontices,andnewadvances[J].Lancet,2021,397(10289):2082-2097.DOI:10.10140-6736(21)00393-7.[5]KangY,TrewernL,JackmanJ,etal.Chronicis[J].BMJ,2023,381:e076036.[6]ElliottAM,SmithBH,HannafordPChecommunity:resultsofa4-yearfollow-upstudy[J].Pain,2002,99(1-2):29307.DOI:10.1016/s0304-3959(02)00138-0.[7]ChenB,LiL,DonovanC,etal.PrevalenceandcharbodypaininChina:anationalstudy[J].Springer/yzygj/ylyxjg/202301/eb45824e37384816be86fa8e6b3ftofchronicpain[J].Diagnostics(Basel),2023,13(24):3689.DOI:10.3390/diag[11]MaoJ.Challengesofmanagingchronicpain[J].BMJ,2017,356:j741.[12]LatypovTH,SoMC,HungPScfacialpainderivedby9.DOI:10.1038/s41598-023-logy[J].NatRevCancer.2018,18(8):500-510.DOI:10.1038/s41568-018-0016-5.[15]DworkinRH,TurkDC,RevickiDA,enofanexpandedandrevisedversionoftheShort-formMcGillPainQuestionnaire(SF-MPQ-2)[J].Pain,2009,144(1-2):35-42.DOI:10.1016/j.pain.2009.02.007.[16]CookKF,KallenMA,BuckenmaierC3rd,etal.Evaluationofandresponseburdenofpatientself-reportmeasuresofthePainAssessmeeningToolandOutcomesRegistry(PASTOR)[J].MilMed,2011.DOI:10.7205/MILMED-D[17]NijsJ,MairesseO,Neurobiology,assessment,andtreatmentinphysicaltherapistpraer,2018,98(5):325-335.DOI:10.1093/ptj/pzy020.23(2):e273-e283.DOI:10.1016/j.bja.2019[19]LancetT.Rethinkingchronicpain[J].La[20]VardehD,MannionRJ,WoolfCJ.Towardamechanism-bandiagnosis[J].JPain,2016,17(9):Suppl-T50.T69DOI:10.1016/j.jpain.2016.0[21]ThemelisK,TangN.Themanagementofchronicpain:re-centringperson-centredcare[J].JClinMed,2023,12(22):6957.DOI:10.3390/jcm12226957.雜志，2023,103(39):3083-3087.DOI:10.3760/l12137-20230704-01135AcadDermatol,2007,57(Suppl6):S136-S142.DOI:10.1016/j[24]GlareP,AubreyKR,Myrsurgery[J].Lancet,2019,393(10180):1537-1546.DOI:10.1016/S0140-6736(19)3[25]GatchelRJ,Reubenionofpainanditsimpact:reportoftheworkgrouponthePreventionofAcuteandChronicPainoftheFederalPainResearchSt837-851.DOI:10.1016/j.jpain.2018.02.015.[26]BadiolaIJ.Canchronicpainbeprevented?[J[27]FrictonJ.Theneedroom"ofhealthcare[J].GlobAdvHealthMed,2015,4(1):6-7.DOI:10.7453/g[28]GewandterJS,DworkinRH,Turkforchronicpainpreventionclinicaltrials:IMMPACTrecommendep,2021,6(1):e895.DOI:10.1097/PR9.0000000000000895.[29]GomezK,SantiagoU,NelsonTS,etCaV2.2N-typecalciumchannelforch23,120(47):e2305215120.DOI:10.1073/pnas.2305215120.[30]WangY,QinD,GuoZ,etal.ResearchprogressonthepotentilgesicBU08028[J].EurJPharmacol,2022,914:174678.DOI:10.1016/j.ejphar.20[31]MorenoAM,AlemánF,CatroliGF,etedinsiturepressionofNaV1.7inmice[J].SciTr