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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,Economic Considerations in the Pharmacologic Management of Pain(,药物治疗疼痛中的经济因素考虑）,Liu Zhan,Xian-Janssen Pharmaceutical Ltd.,2024/11/19,Economic Considerations in the,1,General Introduction of Pain(疼痛概论）,Definition(,疼痛的定义）,Physical pain is a common,subjective and complicated process that is initiated by an unpleasant sensory experience.It occurs via several mechanisms that may result in immobility,deconditioning and emotional reactions.(,躯体疼痛是由于不愉快的感觉经验引起的一种常见的,主观的和复杂的过程.它是通过可引起行动受限,状态异常和情绪反应的一系列机制而发生的.,2024/11/19,General Introduction of Pain,2,Epidemiology(,流行病学资料),75 million people in U.S.have some form of persistent or recurrent pain*and pain is the most common symptom for which patients seek medical assistance*(在美国有超过七千五百万人患有不同程度的持续性或反复发生的疼痛;疼痛已成为患者求医的最常见的症状.,在中国,130万癌症死亡人群中,60%以上忍受着中到重度疼痛,General Introduction of Pain(疼痛概论）,*,Caudill M,Holman G,Turk D.Patient Care.1996:154,*Foley K.Cecil Textbook of Medicine.Philadelphia,1992:97,2024/11/19,Epidemiology(流行病学资料)General I,3,Greatest Challenge(,伟大的挑战),The greatest health care challenge for the next decade is to make the best use of limited available resources to attain the highest quality of health care for the lowest cost.As pharmacoeconomic data become increasingly available,their use in cost-effective pain management and in all health care decisions,will play a major role.The pharmacist is uniquely poised to adapt to this shifting paradigm.*,在下一个十年中,对健康领域里的最大的挑战是充分利用可得到的有限资源,利用最低的花费来得到最高的健康质量.由于药物经济学资料的增加,在疼痛控制健康项目决策中,其花费和结果的研究将起主要作用.,药剂师,们在适应这场变更中起着独一无二的平衡作用.,General Introduction of Pain(疼痛概论）,*Michael Rigas,Economic Considerations in the Pharmacologic Management of Pain.P&Ts 1997:454,2024/11/19,Greatest Challenge(伟大的挑战)Gene,4,Classification of Pain(,疼痛的分类),Temporal Classification(,时间分类),Acute Pain,Chronic Pain,usually defined as that lasting 6 months or longer,the timing,localization and character of the pain are often more vague(,疼痛的时间,部位和性质经常是含糊的),There may be indications of sleep disturbances,loss of appetite,decreased libido,weight loss and depression.(经常伴有睡眠干扰,食欲不振,性欲下降,体重降低及抑郁),Physiologic Classification(,生理学分类),Somatic,Visceral,Neuropathic(,躯体,内脏,神经性),General Introduction of Pain(疼痛概论）,2024/11/19,Classification of Pain(疼痛的分类),5,Pain Management Principles,(,疼痛控制原则)*,Acute Pain,patient education on postoperative pain,the need for regularly scheduled analgesics as opposed to as-needed analgesics for the first 24 hours of more after surgery,the need for frequent assessment and reassessment of pain by nursing personnel,the need for consistent use of a tool for patient self-assessment of pain,the possibility of preemptive analgesic strategies for surgical patients,the specific analgesic strategies offered to patients,General Introduction of Pain(疼痛概论）,*,guidelines and quality assurance standards from the Agency for Health Care Policy and Research(AHCPR),2024/11/19,Pain Management Principles(疼痛控,6,Chronic Pain,WHO analgesic ladder(WHO,阶梯疗法),NonopioidAdjuvant Weak opioid Nonopioid Adjuvant Strong opioid NonopioidAdjuvant,can provide satisfactory pain relief to 70-90%of this patient population*(,可使70-90%的中到重度癌痛患者得到满意地缓解),Durogesic is the novel administration way in chronic pain relief(,多瑞吉的出现创新了慢性痛控制领域里的给药途径),General Introduction of Pain(疼痛概论）,*,WHO cited in Portenoy R.Issues in the economic analysis of therapies for cancer pain.Oncology.1995;9(11):S71,2024/11/19,Chronic PainGeneral Introducti,7,Pharmacologic Therapies of Pain(疼痛的药物治疗),The appropriate and successful management of pain entails selection of the,right analgesic,administered in the,right way,dosage,and on the,right schedule,so as to,maximize pain relief,and,minimize,adverse effects,.*,适当和成功的疼痛控制必需选择正确的止痛药物,正确的途径和剂量以正确的时间间隔给药,从而达到能最大缓解疼痛的同时将副作用降到最小.,Estimates,*Inturrisi C.Management of cancer pain:pharmacology and principles of management.Cancer,1989;63:2308,2024/11/19,Pharmacologic Therapies of Pai,8,Nonnarcotic Analgesics(,非麻醉性镇痛药),Aspirin,Acetaminophen and NSAIDs(,阿斯匹林,对乙酰氨基酚及非甾体抗炎药),first line agents for the treatment of mild-to-moderate pain(,是轻到中度疼痛的一线用药),ceiling effect(天花板效应),an increase in the dosage beyond the recommended maximum dose not result in an increase in analgesia,and potentially increases side effects,not suitable use for chronic,evolving pain*(,不适合用于慢性,进展性疼痛),Pharmacologic Therapies of Pain(疼痛的药物治疗),*,Ashby M.et al,Description of a mechanistic approach to pain management in advanced cancer.Preliminary report.Pain.1992;(51):153,2024/11/19,Nonnarcotic Analgesics(非麻醉性镇痛药,9,Narcotic Analgesics(,麻醉性镇痛药),Narcotic medication should be administered on a regular basis so as to maintain the plasma level of the drug above the minimal effective concentration for pain relief.It is not recommended that patients with chronic pain take narcotics on an as-required basis,because waiting until the pain or distress becomes more severe may actually exacerbate the pain.*,(,麻醉性镇痛
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