良好的疼痛缓解.PPTVIP

慢性疼痛和持续性疼痛 定义：持续性疼痛是指中度到重度，在特定情况下不能自行缓解的疼痛，可能伴有抑郁、焦虑等改变，如不及时治疗，持续6个月以上，即成为慢性疼痛。 对患者影响：生活质量降低，躯体功能障碍，残疾，常伴有焦虑、抑郁甚至自杀企图 治疗目的：减轻疼痛，改善功能 慢性疼痛的最常见原因： 背痛、颈痛、头痛、口面痛 神经病理性疼痛 纤维肌性疼痛 骨骼肌和风湿痛 慢性疼痛治疗的新观念 从单纯镇痛到更加关注付作用 副作用高危人群的确定和分层 区分疼痛的性质（持续痛和爆发痛），分别采用控缓释药物和速释药物 多模式镇痛 慢性疼痛的治疗 阿片类药物仍是主要的镇痛药，不同剂型给药和联合激动药与小剂量拮抗药，激动拮抗药纠正其副作用是主要的关注点 对COX2的中枢机制，曲马多及新的中枢镇痛药的中枢机制，抗惊厥药加巴喷丁和普加巴林的钙通道抑制作用在疼痛中的应用价值 谢谢大家！ 谢谢大家 周末愉快 感谢西安杨森公司提供学术支持 Within the transmission of pain there are 4 processes: transduction, transmission, modulation and perception; NSAIDs COX 2 act only in the transduction process Arachidonic acid is a polyunsaturated fatty acid, one of the essential fatty acids required by most mammals. It is present in the membranes of the bodys cells, and is a precursor in the production of eicosanoids: the prostaglandins, thromboxanes, prostacyclin and the leukotrienes. A prostaglandin is any member of a group of lipid compounds that are derived from fatty acids and have important functions in the animal body. They are mediators and have a variety of strong physiological effects; although they are technically hormones they are rarely classified as such. There are two pathways for metabolism of arachidonic acid to prostaglandins, mediated by COX-1 and COX-2. COX-1 is constitutive and is responsible for the production of prostaglandins that protect the GI tract and maintain normal platelet function. COX-2 controls the production of prostaglandins that mediate inflammation and pain.1,2 NSAIDs inhibit both COX-1 and COX-2 and are non-specific in their mode of action, controlling pain and inflammation but also causing characteristic adverse effects.3 New strategies have focused on the development of therapeutic agents with pharmacological activity based on specific inhibition of COX-2.3 The rationale is that the therapeutic effects of NSAIDs are achieved by COX-2 inhibition, but that many of the toxic effects, most commonly gastroduodenal injury, result from COX-1 inhibition.4 COX-2 is also