慢性原发性疼痛临床管理精神卫生领域专家共识

Expert consensus on clinical management of chronic primary pain in the field of mental health

慢性原发性疼痛(chronic primary pain,CPP)严重影响患者生活及社会功能,是重要的公共卫生问题之一。随着国际疾病分类第11版(International Classification of Diseases 11th Revision,ICD-11)将CPP作为独立疾病纳入分类目录,其普遍性、严重性逐渐受到公众重视,绝大多数CPP患者伴随焦虑、愤怒/沮丧或抑郁等情绪症状。但目前CPP临床实践指南多针对疼痛症状治疗,尚缺乏针对相关情绪症状的临床管理指南或专家共识。本专家共识在循证医学原则指导下,对精神科常用治疗措施进行证据等级和推荐强度分级,其中抗抑郁药、重复经颅磁刺激、经颅直流电刺激、认知行为治疗证据等级均为1A,是CPP重要治疗措施。该共识为临床工作者规范化诊疗CPP提供了证据支持。

Chronic primary pain(CPP),a critical public health problem,seriously affects patients′vital and social function.With the latest International Classification of Diseases(ICD-11)has included CPP as an independent disease,the prevalence and severity of CPP have gradually attracted the public attrention.Most CPP patients also experience emotional symptoms such as anxiety,frustration,and depression.However,the current CPP clinical practice guidelines and expert consensus mainly focus on treating pain symptoms,and there is still a lack of guidance on relevant emotional symptoms.Under the principle of evidence-based medicine,this expert consensus graded the recommendations and levels of evidence.Under the guidance of the principles of evidenced-based medicine,this expert consensus grades the evidence level and recommendation for commonly used psychiatric treatment measures,among which antidepressants,repetitive transcranial magnetic stimulation(rTMS),transcranial direct current stimulation(tDCS)and cognitive behavioral therapy(CBT)are all ranked as 1A.This consensus provides evidence support to standardize the diagnosis and treatment of CPP.