慢性疼痛的綜合管理

承認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)轉向討論長期管理策略[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[8],有助于收集全面的流行病學數(shù)據(jù)，區(qū)分慢性術用于慢性疼痛診斷，有助于提高慢性疼痛的診斷2多維度評估疼痛Baker面部表情疼痛評分量表等單維度疼痛評估量表僅能對疼痛強度進行評估，疼社會因素。慢性疼痛存在感覺、情緒、認知和行為4個維度，推薦疼痛進行評估。簡化的McGill疼痛問卷表2(Shot-formMcgillPainQuestionnaire ,SF-MPQ2)能夠對疼痛性質、疼痛強1.7基因(使用dCas9蛋白實現(xiàn)對NaV1.7的非永久性基因抑制或使用ZFP鋅指蛋白進行表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