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康复咨询与心理学在处理职业性慢性疼痛损伤者中的作用——美国的慢性疼痛与职业损伤
This paper addresses the topic of an interdisciplinary approach of chronic pain management from a biopsychosocial perspective. The first section provides an introduction to the definitions and theories of chronic pain and the various contributing factors (psychological, interpersonal/environmental and social support, and vocational). The second section presents the role of various health care professions (medical doctors, nurses, physical therapists, occupational therapists, psychologists and rehabilitation counselors) and the evidence of their treatment effectiveness. The third section discusses the concept of an interdisciplinary pain rehabilitation program (IPRP) and its evidence to support its effectiveness. Finally, the clinical implications of rehabilitation counseling and psychology as part of the inter-disciplinary program in treating individuals with chronic pain will be highlighted.
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人工髋膝置换术后慢性疼痛原因分析
人工髋、膝关节置换( TKA,THA )是治疗晚期髋、膝关节病变的有效方法,临床10年随访的结果显示,其有效率达92%~98%[1]。然而,疼痛,既是髋、膝关节置换手术的主要适应证,也是人工髋、膝关节置换术的常见并发症。疼痛也是骨关节科的一个普遍的、容易被忽视的问题[2]。人工关节置换术后出现经久不愈的疼痛,预示手术可能失败。人工髋、膝关节置换术后发生慢性持续疼痛的原因虽各有不同,但在大方向分类上,髋膝关节置换术后慢性疼痛有许多一致性,同时在一些具体原因上也有一定相关性,故将两者合并回顾。
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A reduction in gray matter volume is common in patients with chronic back pain, and different types of pain are associated with gray matter abnormalities in distinct brain regions. To examine ences in brain morphology in patients with low back pain or neck and upper back pain, we gated changes in gray matter volume in chronic back pain patients having different sites of pain using voxel-based morphometry. A reduction in cortical gray matter volume was found primarily in the left postcentral gyrus and in the left precuneus and bilateral cuneal cortex of patients with low back pain. In these patients, there was an increase in subcortical gray matter volume in the bilateral putamen and accumbens, right pal idum, right caudate nucleus, and left amygdala. In upper back pain patients, reduced cortical gray matter volume was found in the left precentral and left tral cortices. Our findings suggest that regional gray matter volume abnormalities in low back pain patients are more extensive than in upper back pain patients. Subcortical gray matter volume in-creases are found only in patients with low back pain.
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慢性疼痛等级评价方法
颞下颌关节紊乱病双轴诊断中,心理轴诊断使用的慢性疼痛等级评价(grading chronic pain severity, GCP)是一份由如下 7 个问题组成的自评调查表.
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芬太尼透皮贴剂治疗中、重度慢性非癌症性疼痛临床观察
芬太尼透皮贴剂(Transdermal fentanyl,TDF)为强效麻醉性镇痛药芬太尼的新剂型.目前国内仅限用于晚期癌症的慢性持续性疼痛治疗.近些年,国外除将本品广泛应用于癌症止痛,还大量用于治疗多种难治性慢性非癌性疼痛(Non Cancer Chronic Pain,NCCP),如老年性退行性变、骨关节病、骨质疏松症引发的腰腿痛或各种神经伤害所至的顽固性神经痛等.
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新型阿片类药物在慢性非癌性疼痛治疗中的应用与思考
目前,临床上对慢性非癌性疼痛(Non-Cancer Chronic Pain,NCCP)病人采用阿片类镇痛药治疗往往较为保守,其原因包括主观上对疼痛治疗重视不够、对药物"成瘾性"等副作用心存顾虑、客观上药物控制法规过于严格等.近年来研究表明阿片类药物是NCCP病人的安全有效方法之一,它作为疼痛整体治疗方案的一部分,可改善病人的生活质量,恢复机体功能[1-2].但是,面临的问题和挑战在于如何选择阿片类药物治疗的适应证及合理的疗程,在缓解此类病人疼痛的同时,如何避免药物滥用及可能产生的副作用.
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融合超前镇痛护理理念的急性疼痛服务体系对开胸术后慢性疼痛的影响研究
开胸术后慢性疼痛是指术后持续至少2个月的切口疼痛,以自发痛、牵涉痛、痛觉过敏和痛觉超敏为特征.国外文献报道开胸术后慢性疼痛发生率高达50%~80%,但国内开胸术后慢性疼痛未受到重视.手术和创伤是慢性疼痛的主要病因.研究发现开胸术后慢性疼痛与急性疼痛的程度、性质和处理方式有关.
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老年病人慢性疼痛调查分析及疼痛管理对策
疼痛是困扰老年人的常见症状.由于老年病人疼痛感觉下降和社会认识不足,大部分病人存在的轻到中度持续慢性疼痛易被医生及病人家属忽视[1].长期疼痛严重影响老年人的生理功能、认知、情感和社会关系,导致其生活质量、睡眠质量下降甚至出现抑郁,影响原发疾病的治疗效果[2].所有住院病人都有权要求对其疼痛进行合适的评价和处理,而内科医生往往对病人疼痛重视不够,没有给病人的疼痛提供系统评价和佳解决方案[3].随着我国人口老年化的加快,将会有越来越多的老年病人受其影响.本研究调查我科住院老年病人慢性疼痛的发生率以及疼痛程度、处理方法,探讨针对慢性疼痛的处理方法,以期减轻此类病人的痛苦,提高他们的生活质量.现将结果报道如下.
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偏振红外光照射治疗慢性疼痛的临床观察
疼痛是临床中常见,重要的征象与症状;是一种生理与心理两方面同时经历的感受;是个体的防御功能被破坏,局部特定的神经末梢刺激所引起;是病人就诊的主要原因.为观察偏振红外光的治疗效果,我科护士进行了临床观察.现介绍如下.
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奇曼丁治疗老年人慢性非癌性疼痛的临床观察
慢性非癌性疼痛(Non-Cancer Chronic Pain,NCCP)是临床上常见的症状,尤以老年人多见,许多患者将疼痛作为需要医疗服务的首要因素.
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对慢性疼痛的功能性评价:内科医师可以预测表现吗?
Functional assessment in patients with chronic pain: can physicians predict performance?目的:明确由内科医师评估慢性疼痛病人功能能力的合适性。特殊目的如下:(1)对比内科医师预测的病人功能表现和病人的实际表现。(2)对比在功能评价过程中,内科医师预测的努力与实际所测到的努力。设计:201位有慢性疼痛的门诊病人完成了我们的前瞻性、多中心群体研究。经过训练以完成标准评定的内科医师对病人进行评估并预测病人的表现和努力。治疗医师不知道内科医师的测量结果。由治疗医师对每位病人进行功能评估(大举力和持续举力);重复活动和抓力测定试验(努力的测定)。结果:皮尔森相关检验揭示对于所有的男性病人和女性病人来说,内科医师预测的在各种重复性的活动中和举起各种物体时病人的表现和所观察到的病人的表现之间具有明显的相关性(男性病人:0.52,0.50,0.55;女性病人:0.36,0.40,0.18)。变量分析和后hoc检验发现内科医师预测的努力和测力计所测到的努力之间只在一小亚组病人中一致。结论:一位进行标准测定的经过训练的内科医师可以对慢性疼痛病人的与工作负荷有关的功能能力进行精确的评估。但是医师对努力的预测看起来还值得争议。(AM J Phys Med Rehabil 2001 Mar; 80(3): 162-8)
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慢性疼痛基因治疗相关研究的进展
急性疼痛是组织损伤的生理性预警信号,而慢性疼痛则是一种病理状态[1].慢性疼痛常与痛觉感知、传递和调制有关的神经系统的改变-中枢或外周敏化有关.中枢敏化时神经元的反应性增加,疼痛甚至可以由非痛觉感觉神经纤维的激活产生;而神经末梢伤害感受器长期暴露在组织损伤或炎性产物(如细胞因子、缓激肽、花生四烯酸等)中将产生外周敏化,导致感受器活化阈值降低[2].由于慢性疼痛本身涉及到很复杂的中枢调控机制及神经元的结构重塑,目前的治疗手段和药物的疗效均尚不能令人满意,因此,基因治疗可能的有广阔应用潜在前景[3].
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Low-dose radiation on spinal cord might be a new therapy for intractable chronic cancer and non-cancer pain
Intractable chronic pain is a great challenge in clinic.Central sensitization based on the positive changes of dendritic spines is the main mechanism of intractable chronic pain.And low-dose radiation has been proved to regulate the changes of dendritic spines negatively.Hence,we make a hypothesis that low-dose radiation could relieve cancer and noncancer pain through negatively regulating the shape and reducing the number and density of dendritic spines in the spinal cord.This method is supposed to be a new therapy for intractable chronic pain by expanding indication to non-cancer pain,translocating radiation site from where the tumor exists to special segments of spinal cord and keeping radiation dose at a low level.This therapy would be reliable for relieving non-cancer pain and supply more choices for relieving cancer pain.
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Traditional Chinese medicine nursing protocols for leukorrheal disease (pelvic inflammatory disease)
Leukorrheal disease is an ascending infection of the female genital tract,with high morbidity among reproductive age women.Antibiotics are usually used to treat leukorrheal disease in clinic,but they can lead to a variety of side effects if improper use or long-time use.In recent years,traditional Chinese medicine (TCM) has shown its unique advantages in the treatment of leukorrheal disease.This article mainly explored the key points of common syndromes,TCM nursing methods and health guidance of leukorrheal disease in order to further develop the advantages of TCM,improve its efficacy and standardized its nursing behavior.