医学课件 2015疼痛管理

ESSENTIALPAINMANAGEMENT

疼痛管理

CCBY-NC-SA:ThisworkislicensedunderaCreativeCommonsAttribution-NonCommerical-ShareAlike3.0License.1.1EPMAims

目的Toimproveunderstandingofpain为了提高对疼痛的理解Toteachasimpleframeworkformanagingpain教一个简单管理疼痛的框架，Toreducepainmanagementbarriers为了减轻疼痛管理障碍1.2WorkshopPlan1

工作坊计划1

Painbasics

疼痛的基础知识Whatispain?

疼痛是什么？Whyshouldwetreatpain?我们为什么要治疗疼痛吗？Classificationofpain

疼痛的分类Physiologyandpathology

生理学和病理学Paintreatment

疼痛治疗Barrierstotreatment

治疗的障碍1.3WorkshopPlan2

工作坊计划2Practicalpainmanagement

实用疼痛管理Casediscussions

案例讨论Overcomingbarriers

克服障碍1.4UntreatedPain

未经治疗的疼痛1.5UntreatedPain

未经治疗的疼痛Oftenhidden(notrecognized)

往往隐藏（未确认）Causesalotofsuffering

造成了不少的苦头But…canoftenbetreatedsimplyandcheaply

但是......常常可以??简单和廉价的治疗1.6ApproachtoPain

面對疼痛Recognize

確认Assess评估

Treat

治疗1.7ApproachtoPain

面對疼痛

RRecognize

確认Doesthepatienthavepain?

病人是否有疼痛感吗？

Dootherpeopleknowthepatienthaspain?

其他人知道病人有疼痛吗？1.8ApproachtoPain面對疼痛

AAssess

评估Howsevereisthepain?

疼痛的严重程度如何？Whattypeofpainisit?

是什么类型的疼痛？Arethereotherfactors?

是否还有其他因素？1.9ApproachtoPain面對疼痛

TTreat

治疗Whatnon-drugtreatmentscanIuse?我可以使用什么样的非药物治疗？WhatdrugtreatmentscanIuse?我可以用什么药物治疗？1.10?1.11Introduction介绍

Summary摘要Attheendofthiscourse,youwillbeableto在本课程结束时，您将能够:Understandtheimportanceoftreatingpain了解疼痛治疗的重要性Recognize,assessandtreatdifferenttypesofpain识别，评估和治疗不同类型的疼痛Identifyandaddressbarrierswhereyouwork在你工作哪里识别和克服障碍1.12WhatisPain?什么是疼痛CCBY-NC-SA:ThisworkislicensedunderaCreativeCommonsAttribution-NonCommerical-ShareAlike3.0License.2.1WhatisPain?什么是疼痛

Aims目的Todefinepain定义疼痛

Togiveexamplesofpain为了给疼痛的例子2.2WhatisPain?什么是疼痛Groupdiscussion小组讨论Thinkofapatient/friend/relativewhohadpain想想疼痛的患者/朋友/亲戚人.Howdidthepersondescribethepain?人怎么形容痛苦？Howwasittreated?如何治疗？2.3WhatisPain?什么是疼痛InternationalAssociationfortheStudyofPain国际疼痛研究协会Painis"anunpleasantsensoryandemotionalexperienceassociatedwithactualorpotentialtissuedamage,ordescribedintermsofsuchdamage”.

疼痛是“与实际或潜在的组织损伤相关的不愉快的感觉和情绪体验，或描述这种损害的。”Whatdoesthismean?这是什么意思？

Arethereanyotherdefinitions?是否有任何其他的定义？

2.4WhatisPain?什么是疼痛Unpleasant不愉快Emotionsareimportant情绪是重要的Thecauseisnotalwaysvisible原因并不总是可见“Painiswhatthepatientsayshurts.”“疼痛是病人说什么伤害。”2.5Isthismanfeelingpain?

这男人有疼痛的感觉吗？

2.6?2.7WhatisPain?什么是疼痛

Summary摘要Painisanunpleasantsensoryandemotionalexperience疼痛是一种不愉快的感觉和情绪体验

Painiswhatthepatientsayshurts!疼痛是什么病人说好痛！2.8WhyShouldWeTreatPain?

我们为什么要治疗疼痛？CCBY-NC-SA:ThisworkislicensedunderaCreativeCommonsAttribution-NonCommerical-ShareAlike3.0License.

3.1WhyShouldWeTreatPain?

我们为什么要治疗疼痛？

Aims目的Tounderstandthereasonsfortreatingpain要了解治疗疼痛的原因Tounderstandthebenefitsforthepatient,familyandsociety

要了解??病人，家庭和社会带来的好处3.2Case1MrTisa29-year-oldmanwithafastgrowingmouthcancerthathasspreadtohisbones.Hehasseverefacepain.Heisexpectedtodiewithin6monthsandthesurgeonsdonotwanttooperate.Heismarriedwithtwochildren,aged11and8T先生是一个29岁的男子,一个快速增长的口腔癌已经扩散到他的骨头。他有严重的面部疼痛。他预计，6个月内死亡，外科医生不想要操作。他已婚，有两个孩子，11岁和8岁

Whyshouldwetreathispain?我们为什么要治疗他的疼痛?3.3Case2MrsGisa54-year-oldwomanwhohasjusthadalaparotomyforbowelobstruction.Youseeheronthesurgicalwardsoonaftertheoperation.Sheappearstobeinpain.G太太是一个54岁的女人，刚刚接受了剖腹探查肠梗阻。手术后不久,你在外科病房看她，她似乎是在痛苦中。Whyshouldwetreatherpain?我们为什么要治疗她的疼痛?3.4WhyPainMatters为什么疼痛是重要Forthepatient:对于病人:

Physical身體Suffering,poorsleep,decreasedappetite痛苦，睡眠不好，食欲下降Medicalcomplications医疗并发症 (e.g.heartattack,pneumonia)（例如心脏病发作，肺炎）Psychological心理Depression,anxiety抑郁，焦虑3.5WhyPainMatters为什么疼痛是重要Forthefamily对于家庭Unabletofunctionaspartofthefamily (e.g.asafather/mother)无法充当家庭的一部分（例如，作为一个父亲/母亲）Lostincome收入损失Forsociety对于社会Greaterhealthcosts更大的医疗费用 (e.g.delayedhospitaldischarge)

（例如延迟出院）Unabletocontributetothecommunity

无法对社会作出贡献3.6PainfulSCC(xerodermapigmentosum)

疼痛的鳞状细胞癌

3.7AdvantagesofTreatingPain

治疗疼痛的优点Forthepatient对于病人Fewerphysicalandpsychologicalproblems较少的生理和心理问题Greaterdignity(esp.cancerpain)更有尊严（特别是癌症疼痛）Forthefamily对于家庭Abletofunctionaspartofthefamily能够充当家庭的一部分Abletoprovideforfamily能够提供家庭Forsociety对于社会Lowerhealthcosts降低医疗费用

3.8?3.9WhyShouldWeTreatPain?

我们为什么要治疗疼痛？

Summary摘要Treatingpainisthe“humane”thingtodo!治疗疼痛是“人性化”的事情！Treatingpainhasmanybenefits治疗疼痛有很多好处Forthepatient对于病人Forthefamily对于家庭Forsociety对于社会3.10ClassificationofPain

疼痛的分类CCBY-NC-SA:ThisworkislicensedunderaCreativeCommonsAttribution-NonCommerical-ShareAlike3.0License.4.1ClassificationofPain疼痛的分类

Aims目的Toclassifytypesofpain要分类疼痛的类型Tounderstandthattreatmentdependsonthepaintype

治疗取决于疼痛的类型4.2ClassificationofPain疼痛的分类Notallpainisthesame!并不是所有的疼痛是一样的！Threemainquestions:三个主要问题：Howlonghasthepatienthadpain?患者痛苦多久了？Whatisthecause?是什么原因呢？Whatisthepainmechanism?疼痛的机制是什么？4.3ClassificationofPain疼痛的分类Duration時期Acute急性Chronic慢性病Acuteonchronic急性慢性Cause成因Cancer癌症

Non-cancer非癌Mechanism机制Nociceptive(physiological)伤害性（生理）Neuropathic(pathological)神经性（病理）4.4AcuteversusChronic急性与慢性Acute急性Painofrecentonsetandprobablelimitedduration

最近发生的疼痛,和持续时间可能有限Chronic慢性病Painpersistingbeyondhealingofinjury无法医治受伤的疼痛坚持Oftennoidentifiablecause往往没有可识别的原因(Painlastingformorethan3months)

（疼痛持续3个月以上）4.5CancerversusNon-Cancer

癌症和非癌性疼痛Cancerpain癌症疼痛Progressive增进Maybemixtureofacuteandchronic

可能是混合的急性和慢性Non-cancerpain非癌性疼痛Manydifferentcauses许多不同的原因Acuteorchronic急性或慢性Canyougiveexamples?你能不能给例子吗？

4.6Invasiveoralcancer侵袭性口腔癌

4.7NociceptivePain伤害性疼痛Obvioustissueinjuryorillness明显的组织损伤或疾病“Physiologicalpain”“生理痛苦”Description描述Sharp±dull尖銳±沉闷Welllocalised局限的

Canyougiveexamples?你能不能给例子吗？4.8NeuropathicPain神经病理性疼痛

Nervoussystemdamageorabnormality神经系统损伤或异常“Pathologicalpain”

“病理性疼痛”Tissueinjurymaynotbeobvious组织损伤可能不是很明显Description描述Burning,shooting±numbness,pinsandneedles燃烧，拍摄±麻木，别针和针头Notwelllocalised不是局限的

Canyougiveexamples?你能不能给例子吗？4.9ExamplesofPainTypes

疼痛类型的例子4.10AcuteNon-CancerPain急性非癌症疼痛Examples示例Fracture,appendicitis骨折，阑尾炎Symptomoftissueinjuryorillness组织损伤或疾病的症状Useful有用Usuallynociceptive通常痛觉Occasionallyneuropathic(e.g.sciatica)偶尔神经性（如坐骨神经痛）4.11ChronicNon-CancerPain慢性非癌症疼痛Examples示例Headache,backpain头痛，背痛Usuallynoobviousinjury一般无明显损伤Notuseful没有用Complex,maybemixednociceptiveandneuropathic复杂，可能会伤害性和神经性混合Doesnotrespondtousualdrugtreatment

通常的药物治疗不回应

4.12CancerPain癌症疼痛

Examples示例Oralcancer,uterinecervicalcancer口腔癌，子宫颈癌Featuresofacuteandchronicpain急性和慢性疼痛的特点Maybeacuteonchronic可能是急性慢性Oftenmixednociceptiveandneuropathicpain常混的伤害性和神经性疼痛Usuallygetsworseovertimeifuntreated

如果不及时治疗,通常随着时间变得更糟4.13?4.14ClassificationofPain疼痛的分类

Summary摘要

Decidingonthetypeofpainisimportant重要的是确定不同的疼痛Acute/chronic急性/慢性Cancer/non-cancer癌症/非癌症的Nociceptive/neuropathic伤害/神经痛Treatmentdependsonthepaintype

治疗取决于疼痛的类型4.15PainPhysiologyandPathology

疼痛的生理学和病理学CCBY-NC-SA:ThisworkislicensedunderaCreativeCommonsAttribution-NonCommerical-ShareAlike3.0License.5.1PainPhysiologyandPathology

疼痛的生理学和病理学

AimsTounderstandnormalpainphysiology要了解正常的生理疼痛Painpathway疼痛通路Factorsaffectingthepainsignal影响疼痛信号的因素Tounderstandthebasisofneuropathicpain(pathology)

要了解基础神经性疼痛（病理学）5.2NociceptionandPain痛觉和疼痛

Nociception痛觉Howpainsignalsgetfromthesiteofinjurytothebrain疼痛信号如何从受伤的部位到大脑Painperception疼痛的感知Howwe“feel”pain我们如何“感觉”痛Nociceptionisnotthesameaspain!

痛觉和疼痛是不一样的！

5.3Isthismanfeelingpain?

这男人有疼痛的感觉吗？

5.4Pain疼痛Whatthepatientsayshurts.Whatmustbetreated.

病人说什么伤害。

我们必须接受治疗。Injury外伤

Beliefs/concerns信仰/关注

aboutpain关于疼痛？

Psychol.factors心理因素anxiety/anger/depression

焦虑/愤怒/抑郁症

Culturalissues文化Language,expectations

语言，期望

Otherillnesses其他疾病

Copingstrategies应对策略

Socialfactors社会因素e.g.family,work

例如家庭，工作

Nociceptionisnotthesameaspain!

痛觉和疼痛是不一样的！ModifiedfromAnalgesicExpertGroup.TherapeuticGuidelines20075.5Physiology生理学4steps4个步骤:Periphery外围Spinalcord脊髓Brain脑Modulation调制Wewilllookateachstep我们将着眼于每一个步骤：

5.6Periphery外围Tissueinjury组织损伤Releaseofchemicals释出化学物Stimulationofpainreceptors(nociceptors)刺激疼痛感受器SignaltravelsinAδorCnervetospinalcord

信号在Aδ或C神经，脊髓5.7SpinalCord脊髓Dorsalhornisthe“firstrelaystation”脊髓背角是“第一个中继站”AδorCnervesynapses(connects)withsecondnerveAδ或C神经突触（连接）与第二神经Secondnervetravelsupoppositesideofspinalcord第二神经二对面脊髓神经传播5.8Brain脑Thalamusisthe“secondrelaystation”丘脑是“第二个中继站”Connectionstomanypartsofthebrain连接到许多部位Cortex脑皮质Limbicsystem边缘系统Brainstem脑干Painperceptionoccursinthecortex

疼痛的感知发生在皮层5.9Modulation调制Descendingpathwayfrombraintodorsalhorn递减通路从脑皮质脑脊髓背角Usuallydecreasespainsignal

通常减少疼痛信号5.10Whyispainphysiologyimportant?为什么疼痛生理学是重要？Manyfactorsaffecthowwe“feel”pain.许多因素会影响我们如何“感觉”疼痛Psychologicalfactorsareveryimportant.心理因素是非常重要的Differenttreatmentsworkondifferentpartsofthepathway.不同的治疗方法在不同的途径上工作Morethanonetreatmentmaybeneeded.

可能需要一个以上的治疗。5.11NeuropathicPain神经病理性疼痛

“Pathological”pain“病态”的痛Abnormalityof异常的：Peripheralnerves周围神经Spinalcordorbrain脊髓或大脑Needstobetreateddifferently

需要区别对待5.12NeuropathicPain神经病理性疼痛Peripheral

Damagednerves(e.g.trauma,diabetes)受损的神经（如外伤，糖尿病）Abnormalfiringofnerves神经异常放电Central中央Changesin“wiring”“接线的变化”Abnormalfiring烧制异常Lossofmodulation调制亏损Howdopatientsdescribetheirpain?

病人怎么形容他们的痛苦呢？

5.13?5.14PainPhysiologyandPathology

疼痛生理学和病理学

Summary摘要Manyfactorsaffecthowwe“feel”pain.许多因素会影响我们如何“感觉”疼痛。Differenttreatmentsworkondifferentpartsofthepainpathway.不同的治疗方法在不同的途径上工作Neuropathicpainis“pathological”painandneedstobetreateddifferently.

神经病理性疼痛是“病态”的痛苦和需要区别对待。

5.15PainTreatmentOverview

疼痛治疗概述CCBY-NC-SA:ThisworkislicensedunderaCreativeCommonsAttribution-NonCommerical-ShareAlike3.0License.6.1PainTreatmentOverview

疼痛治疗概述

AimsTodiscussnon-druganddrugtreatmentswhereyouwork讨论在你工作哪里,非药物和药物治疗Toclassifypaintreatments

疼痛治疗要分类6.2PainTreatment疼痛治疗Groupdiscussion小组讨论Whatnon-drugtreatmentsareavailablewhereyouwork?在你工作哪里,什么非药物治疗是可以的？Whatdrugtreatmentsareavailablewhereyouwork?在你工作哪里,什么药物治疗是可以的？

6.3Non-DrugTreatments非药物治疗

Physical物理Rest,ice,compression,elevation休息，冰敷，加压，抬高Surgery手术Acupuncture,massage,physiotherapy针灸，按摩，理疗Psychological心理Explanation解释Reassurance放心Counseling辅导

6.4PlaceboTreatment安慰剂治疗

Groupdiscussion小组讨论

Whatisplacebo?安慰剂是什么？Isithelpfulorunhelpful?它是有益还是无益？

6.5PlaceboTreatment安慰剂治疗Psychologicalfactorsareimportant.心理因素是很重要的。Ifaplacebotreatmentworks,thisdoesnotmeanthepatientdidnothavepainorwastellinglies!

如果安慰剂治疗的工作，这并不意味着患者没有疼痛或在说假话！6.6DrugClassification药品分类Simpleanalgesics简单的止痛剂Paracetamol(acetaminophen)扑热息痛（对乙酰氨基酚）Anti-inflammatorymedicines抗炎药Aspirin,ibuprofen阿司匹林，布洛芬

Opioids阿片类药物Mild温和Codeine可待因Strong强烈Morphine,pethidine吗啡，杜冷丁6.7DrugClassification药品分类Otheranalgesics其他镇痛药

Amitriptyline阿米替林Carbamazepine卡马西平Localanaesthetics局部麻醉药Ketamine氯胺酮Tramadol曲马多Clonidine可乐定Entonox安桃乐(N2O/O2)6.8Treatments-Periphery治疗-外围Non-drugtreatments非药物治疗Rest,ice,compression,elevation休息，冰敷，加压，抬高Anti-inflammatorymedicines抗炎药Localanaesthetics局部麻醉药6.9Treatments-SpinalCord治疗-脊髓Non-drugtreatments非药物治疗Acupuncture,massage针灸，按摩Localanaesthetics局部麻醉药Opioids阿片类药物Ketamine氯胺酮

6.10Treatments-Brain治疗-脑Non-drugtreatments非药物治疗Psychological心理Drugtreatments药物治疗Paracetamol扑热息痛Opioids阿片类药物Amitriptyline阿米替林Clonidine可乐定

6.11?6.12PainTreatmentOverview

Summary疼痛治疗概述摘要Bothnon-druganddrugtreatmentsareimportant.两种非药物和药物治疗是很重要的Differenttreatmentsworkondifferentpartsofthepainpathway.不同的治疗方法在不同的途径上工作Analgesicscanbeclassifiedintosimpleanalgesics,opioidsandotherdrugs.。

镇痛剂可分为简单的镇痛药，阿片类药物和其他药物。6.13PainDrugs

止痛药CCBY-NC-SA:ThisworkislicensedunderaCreativeCommonsAttribution-NonCommerical-ShareAlike3.0License.7.1PainDrugs止痛药

Aims旨在Tosummarisethemajoradvantagesanddisadvantagesofimportantdrugs总结重要的药物的主要优点和缺点Todiscussdrugaddiction

要讨论毒瘾7.2Paracetamol(Acetaminophen)扑热息痛（对乙酰氨基酚）Advantages优点Cheap,safe价格便宜，安全Canbegivenorallyorrectally可以口服或直肠给药Goodfor适合:Mildpain(byitself)轻度疼痛Mod-severepain(withotherdrugs)剧烈疼痛（与其他药物）Disadvantages缺点Liverdamageinoverdose过量的肝损害

7.3Anti-InflammatoryMedicines

抗炎药Aspirin,ibuprofen阿司匹林，布洛芬Advantages优点Cheap,generallysafe价格便宜，一般安全Goodfornociceptivepain适合伤害性疼痛Bestgivenregularlywithparacetamol最好定期与扑热息痛??Disadvantages缺点Gastrointestinalandrenalsideeffects

胃肠道和肾脏的副作用7.4Codeine可待因Advantages优点Cheap,safe价格便宜，安全Goodformild-moderateacutenociceptivepain适合轻中度急性伤害性疼痛Bestgivenregularlywithparacetamol最好定期与扑热息痛??Disadvantages缺点Constipation便秘Notgoodforchronicpain不适合慢性疼痛Mythsaboutaddiction关于毒瘾的神话

7.5OpioidsandAddiction

阿片类药物成瘾Groupdiscussion小组讨论Doopioidscauseaddiction?阿片类药物引起毒瘾？Wouldthisstopyougivingopioidstoapatientwhohaspain?这会阻止你给予有疼痛的病人阿片类药物吗？

7.6OpioidsandAddiction

阿片类药物成瘾Painissometimespoorlytreatedbecauseofconcernsaboutaddiction.有时疼痛治疗不当因为担忧毒瘾Addictionisveryrarein成瘾是非常罕见的:Acutepain急性疼痛

Cancerpain癌症疼痛Addictionismorelikelyinchronicnon-cancerpain.。慢性非癌性疼痛更容易成瘾。7.7Morphine1吗啡Advantages优点Cheap,generallysafe价格便宜，一般安全Canbegivenorally,IV,IM,SC可以口服，IV，IM，SCEffectiveifgivenregularly，如果定期给有效的Goodfor适合：:Mod-severeacutenociceptivepain(e.g.post-oppain)国防部严重急性伤害性疼痛（例如术后疼痛）Chroniccancerpain

慢性癌症疼痛7.8Morphine2吗啡Disadvantages缺点Constipation便秘Respiratorydepressioninhighdose高剂量抑制呼吸Mythsaboutaddiction关于毒瘾的神话Regulationsaboutuse关于使用条例

7.9Pethidine杜冷丁Advantages优点Cheap廉价Canbegivenorally,IV,IM可以口服，IV，IMCanbegoodforsevereacutenociceptivepain可以好严重急性伤害性疼痛Disadvantages缺点Mustbegivenmoreoftenthanmorphine往往比吗啡必须给予更多Breakdownproduct(norpethidine)cancauseconvulsions击穿生产（norpethidine的）可引起惊厥Notgoodforchronicpain不适合慢性疼痛

7.10Amitriptyline阿米替林Increasesdescendinginhibitorysignals增加下行抑制信号Advantages优点Cheap,safeinlowdose价格便宜，安全，低剂量Goodforneuropathicpain适合神经性疼痛Alsotreatsdepression,poorsleep?治疗抑郁症，睡眠不佳Disadvantages缺点Anti-cholinergicsideeffects(glaucoma,urinaryretention)抗胆碱能副作用（青光眼，尿潴留）

7.11Anti-EpilepticDrugs抗癫痫药物Carbamazepine(Tegretol)卡马西平（得理）Sodiumvalproate(Epilim)丙戊酸钠（Epilim）“Membranestabilisers”“膜稳定剂”Reduceabnormalfiringofnerves减少异常神经烧成Goodforneuropathicpain

适合神经性疼痛

7.12Entonox(N2O/O2)安桃乐Advantages优点Fastonset/fastoffset起效快/快抵消Goodfor:适合：Labourpains劳工痛苦Shortpainfulprocedures(e.g.dressingchanges)

短痛苦的程序（如换药）Disadvantages缺点Needcylinderandmask

需要缸和掩码7.13DrugTreatments药物治疗Acutenocimild急性疼痛轻微Acutenocisevere急性疼痛严重Acuteneuro急性神经痛Chronicnon-cancer慢性非癌性疼痛Chroniccancer慢性癌症疼痛Paracetamol扑热息痛++++++++NSAIMs非甾体抗炎药+++++±±Codeine可待因+++±Morphine吗啡+++++-+++Amitriptyline阿米替林--++++++Carbamazepine卡马西平--++++7.14?7.15PainDrugs止痛药

Summary摘要Paincanbetreatedwithrelativelycheapandsafedrugs.疼痛可使用相对廉价和安全的药物治疗Opioidaddictionisrareinacuteorcancerpain。

阿片类药物成瘾??急性或癌症疼痛是罕见的.7.16BarrierstoPainTreatment

疼痛治疗的障碍CCBY-NC-SA:ThisworkislicensedunderaCreativeCommonsAttribution-NonCommerical-ShareAlike3.0License.8.1BarrierstoPainTreatment

疼痛治疗的障碍

Aims旨在Tounderstandsomeofthereasonswhypainmaynotbetreatedadequately要理解一些原因疼痛可能无法得到适当处理Tothinkaboutsomesolutions

要想想一些解决方案8.2BarrierstoPainTreatment

疼痛治疗的障碍GroupDiscussion小组讨论Painisoftennottreatedaswellasitcouldbe.Whataresomeofthereasonsforthis?疼痛往往是不及时治疗，这种情况的原因有哪些？Patients患者Drugs药物Healthworkers卫生工作者Systemissues系统问题Whatarethemainbarrierswhereyouwork?在你工作哪里,主要障碍是什么？Whatcanbedoneaboutthesebarriers?有关这些障碍可以做什么？

8.3?8.4BarrierstoPainTreatment

Summary疼痛治疗的障碍

摘要Therearemanyreasonswhypainisnottreatedaswellasitcouldbe.有许多原因为什么疼痛不被视为以及它可能是。Importantbarriersareattitudes,lackofstaffandlackofdrugs.重要的障碍是态度，缺乏工作人员和药品缺乏。HowcanYOUovercomethesebarrierswhereyouwork?在你工作哪里,你如何才能克服这些障碍，？

8.5BasicApproachtoPainManagement

疼痛管理的基本方法CCBY-NC-SA:ThisworkislicensedunderaCreativeCommonsAttribution-NonCommerical-ShareAlike3.0License.9.1BasicApproach基本方法

Aims目的是Togiveasimpleframeworkformanagingpatientswithpain举一个简单的框架，管理患者疼痛Toillustratetheuseofthisframeworkfordifferenttypesofpain

说明在此框架中不同类型的疼痛的使用9.2ApproachtoPain

疼痛9.3ApproachtoPainRecognize认识

Assess评估Treat治疗9.4ApproachtoPain

Recognize认识

Doesthepatienthavepain?病人是否有疼痛感吗？Ask问Look(frowning,movingeasily,sweating?)看（皱着眉头，移动方便，出汗？）Dootherpeopleknowthepatienthaspain?其他人知道病人有疼痛吗？Otherhealthworkers其他卫生工作者Patient’sfamily病人家属

9.5ApproachtoPain

Assess评估Measuretheseverity严重性的测量Whatisthepainscore?

疼痛比分是什么？Atrest在休息Withmovement在运动Howisthepainaffectingthepatient?痛苦如何影响了患者呢？Canthepatientmove,cough?病人的举动，咳嗽吗？Canthepatientwork?患者??工作吗？

9.6MeasuringPain测量疼痛Helpsguidetreatment帮助指导治疗Methods方法Verbal(e.g.mild,moderate,severe)口头（如轻度，中度，重度）Numerical数字的0(nopain)to10(worstpainimaginable)

0（无疼痛）到10（可想最差的痛苦）Visual视觉的VisualAnalogueScale(VAS)视觉模拟评分法（VAS）“Faces”painscale“面孔”疼痛量表

9.7VisualAnalogueScale

视觉类比量表9.8询问病人，以显示他们的痛苦是表上的1到10无疼痛可想最差的痛苦FacesPainScale面孔疼痛量表9.9询问病人，以点代面，这表明他们的痛苦是多么糟糕ApproachtoPain

Assess评估Makeapaindiagnosis!疼痛诊断！

Acuteorchronic?急性或慢性？Cancerornon-cancer?癌症和非癌症？Nociceptiveorneuropathic?伤害性或神经性？Lookforneuropathicfeatures:寻找神经痛功能：Burningorshootingpain燃烧或拍摄疼痛Phantomlimbpain幻肢痛Otherfeatures(pinsandneedles,numbness)其他功能（如坐针毡，麻木）9.10ApproachtoPain

Assess评估Arethereotherfactors?是否还有其他因素？Physicalfactors(otherillnesses)物理因素（其他疾病）Psychologicalandsocialfactors心理和社会因素Anger,anxiety,depression愤怒，焦虑，抑郁Lackofsocialsupports缺乏社会支持

9.