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Click to View疼痛综合管理:展望无痛诊疗的未来
北京协和医学院临床医学(八年制)2016级 浦军
作为第五大生命体征的疼痛,不仅会引起患者躯体不适和心理变化,影响康复进程,同时也给社会带来了巨大医疗负担。如何减轻患者疼痛已成为临床及大众共同关注的热点话题。本期《协和医学杂志》重点选题方向为"疼痛综合管理",旨在探讨近年来我国在术后急性疼痛、无痛舒适化诊疗、疑难慢性疼痛、多模式疼痛管理等方面取得的主要进展。
如何通过艺术手段展现疼痛综合管理理念是本期封面创作的重点和难点。通过翻阅大量资料,决定推翻最初欲采用疼痛评分量表来展现主题的设想,转而借鉴墨西哥弗里达卡罗画作中对疼痛的表现手法来展现这一主题。最终,画面主体以荆棘交织成网遮住夜空寓意疼痛,红色荆棘指代疼痛缠扰下患者的焦灼难安;而医生帮助患者拨开荆棘现出月光寓意镇痛,月色清冷喻示消除疼痛后的清凉宁静。整个画面以患者的第一视角穿破荆棘沐浴月光,共情长久困扰于疼痛后获得的无痛舒适体验,同时刻画医患双方并力向前,为无痛未来并肩探索的美好现状。
相信随着"舒适无痛诊疗"理念的深入传播,医疗机构和医护人员的疼痛综合管理服务意识与服务能力也将不断提升,可帮助患者在就医过程中收获更强烈的幸福感和安全感。
Chinese Bimonthly
CN 11-5882/R
ISSN 1674-9081
Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).
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Abstract:
Postoperative pain seriously affects the recovery process of patients, resulting in prolonged hospital stay and increased care costs. Appropriate application of patient-controlled analgesia devices can effectively relieve perioperative acute pain. In 1994 patient-controlled analgesia began to be used in Peking Union Medical College Hospital, and the Acute Pain Service Working Group was established in 2004. With the cooperation of anesthesiologists and specialist nurses, the group jointly has implemented the whole process and standardized management based on patient-controlled analgesia, and constantly improved and innovated working methods, laying a solid foundation for the development of postoperative pain management. This paper systematically reviews and summarizes the work from the aspects of clinical focus, nursing management experience, promotion and dissemination of pain treatment concepts, and development of acute pain service model under the new situation, with the hope of providing valuable reference for comprehensively strengthening pain management in the process of diagnosis and treatment, and enhancing patients' satisfaction with perioperative analgesia services.
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Abstract:
Epidural labor analgesia aims to provide effective medical services to alleviate labor pain in parturients, while adhering to the principles of voluntary participation and clinical safety. In 2018, Peking Union Medical College Hospital(PUMCH)became one of the first pilot units for labor analgesia in China, and has achieved satisfactory results in high-quality development of labor analgesia. This article mainly introduces the achievements and experience of labor analgesia at PUMCH, including: (1) prioritizing maternal and infant safety, arranging personnel rationally, and developing standardized treatment processes through multidisciplinary collaboration to ensure safe and comfortable childbirth; (2) leveraging the hospital's comprehensive capabilities in emergency treatment, and improving collaborative rescue plans for critically ill parturients and newborns; (3) implementing advanced teaching methods to effectively train and conduct simulated drills for labor analgesia and rescue of critically ill parturients; (4) conducting patient education and informative lectures to help parturients acquire a scientific understanding of labor analgesia. We hope that this experience can provide reference and inspiration for other hospitals.
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2024, 15(2): 251-257.
doi: 10.12290/xhyxzz.2023-0574
Abstract:
Pain management, listed as the fifth vital sign, has gained increasing attention from clinicians. Conventional analgesics have limited duration, leading to intense monitor and frequent dosing during the early phase in order to prevent the progression of chronic pain. Thus, prolonging the duration of analgesics has become one focus of the pain research. Several strategies, such as adding adjuvants, producing derivatives, and applying extended-release carriers, make it possible for super long-acting analgesics to come into reality. This review briefly introduces the strategies and development of the super long-acting analgesics, including the successful translation and commercialization of the present products of super long-acting analgesics. It also summarizes the application and translation of extended-release drug carriers, providing invaluable reference for the future research on the field of super long-acting analgesics.
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2024, 15(2): 258-264.
doi: 10.12290/xhyxzz.2023-0552
Abstract:
The baroreceptor reflex is an essential mechanism for the autonomic nervous system in cardiovascular homeostasis and is closely related to pain regulation. Baroreflex sensitivity (BRS) is an indicator for quantitative evaluation of baroreflex reflex function. Pain sensitivity is negatively correlated with BRS, therefore, BRS has potential application prospects in pain risk prediction and therapeutic efficacy assessment. Vagus nerve stimulation, capable of activating the baroreceptor reflex, has been widely used in acute or chronic pain patients in recent years. This article reviews the mechanism and clinical application progress of the baroreceptor reflex in pain regulation, with the hope of providing reference for further exploring treatment to regulate baroreceptor reflex function in pain treatment.
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2024, 15(2): 265-271.
doi: 10.12290/xhyxzz.2023-0591
Abstract:
Central post-stroke pain (CPSP), a neuropathic pain syndrome occurring after a cerebrovascular accident, is characterized by pain or paraesthesia in the part of the body dominated by the area of the brain where blood vessels are injured. CPSP patients are often accompanied by anxiety, depression and other emotional disorders, which have a serious negative impact on patients' quality of life. However, the pathogenesis of CPSP has not been fully elucidated, the clinical diagnosis rate is not high, and the commonly used treatment methods are not effective. This article reviews the clinical features, epidemiology, pathogenesis and treatment of CPSP in order to provide reference for the elucidation of CPSP mechanism and effective treatment.
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2024, 15(2): 272-278.
doi: 10.12290/xhyxzz.2023-0519
Abstract:
Pain not only affects the physical and mental health of individuals, but also imposes a huge burden on society as a whole. Traditional pain management measures are diverse, but each has its limitations. Therefore, there is an urgent need for new tools. Digital therapies are booming, and virtual reality (VR) has been widely used, especially in the field of pain management. VR uses assistive tools, such as headsets, to build a three-dimensional virtual world with the participation of multiple senses, including vision, hearing, and smell, so that it can make user feel being there. This review aims to summarize the application and mechanism of VR in the field of pain management, with the hope of making VR a new choice for pain management.
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2024, 15(2): 279-284.
doi: 10.12290/xhyxzz.2023-0429
Abstract:
In recent years, with the gradual and extensive application of digital medical treatment in the field of medica anesthesia, its role in the postoperative pain management of children has attracted increasing attention. It provides new ideas for the preoperative prediction, postoperative monitoring and evaluation, and treatment management of postoperative pain in children, as well as a new scheme for anesthesiologists to formulate the best postoperative pain management strategy for children. This article reviews digital medical treatment and its application in clinical anesthesia, and reviews the application prospects of this therapy in postoperative pain in children, in order to deepen clinicians' knowledge.
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