【美国三院报告】【疼痛的治疗和阿片药流行：处方阿片类药物与社会及个人的风险和效益的平衡】李永明博士。纽约中医论坛
2017/7/16 纽约TCM论坛

    

    

     (图片来自网络)

     【美国三院报告】疼痛的治疗和阿片药流行：处方阿片类药物与社会及个人的风险和效益的平衡

     阿片滥用及疼痛治疗管理委员会

     美国科学院、工程科学院、医学科学院 2017 报告

     【注：从奥巴马政府开始意识到美国处方阿片类药滥用问题，并提出反滥用止痛处方药战略计划以来，美国白宫、参众两院及特朗普新政都一致支持要这个国家计划，并投入大量资金。美国科学及医学界众多组织和专家推荐针灸作为疼痛的常规一线治疗方法。这次美国最高学术机构“三院”( 美国科学院、工程科学院、医学科学院，2017 报告)的报告里多次提到针灸疗法治疗疼痛的内容，对针灸发展意义重大，被视为针灸发展的历史机遇。

     值得提及的是，上一次美国“三院”有关针灸的联合报告发表于1976年，题目为《针刺麻醉在中华人民共和国》。经“三院”派出的联合专家组到中国实地考察3周，专家组的最后结论是，针刺麻醉是真实的，此麻醉方法只适合少数患者，但针刺镇痛的临床意义重大，需要深入研究。

     可惜，报告发表时，正值中国文革结束和改革开放的开始，针灸疗法因政治原因被遗弃，西医西药因开放而涌入，美国“三院”专家对针灸的中肯意见没有受到中国有关方面的重视，甚至这份报告至今没有中文版(见《美国针灸热传奇》，157页)。

     希望这一次，中国不要错过加入世界反滥用止痛药的行动，用中国古老的针灸术为世界人民服务。(李永明)】

     附原文同针灸疗法有关的部分摘要。如需引用，请读原文(共393页)

     Copyright ? National Academy of Sciences. All rights reserved.

     Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use

     PAIN MANAGEMENT AND THE OPIOID EPIDEMIC

     BALANCING SOCIETAL AND INDIVIDUAL BENEFITS AND RISKS OF PRESCRIPTION OPIOID USE

     Committee on Pain Management and Regulatory Strategies to Address

     Prescription Opioid Abuse

     Richard J. Bonnie, Morgan A. Ford, and Jonathan K. Phillips, Editors

     Board on Health Sciences Policy

     Health and Medicine Division

     A Consensus Study Report of

     National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24781.

     非药物疗法治疗：针灸

     Page 2-27

     NONPHARMACOLOGIC TREATMENTS

     Acupuncture The use of acupuncture for the treatment of pain has become widespread in recent decades. Acupuncture is a key component of traditional Chinese medicine that involves insertion of needles through the skin to acupuncture points. Pressure, heat, electrical current, laser light, and other means also may be used to stimulate these points. Investigations have demonstrated that the nervous system, neurotransmitters, and other endogenous substances respond to the needling stimulation to induce analgesia (Foster and Sweeney, 1987). It has been shown that acupuncture analgesia is mediated by opioids produced in the periaqueductal gray and can be reversed by naloxone, an opioid antagonist (Cheng and Pomeranz, 1980). Recent studies also suggest activation of cannabinoid receptors as a possible mechanism of action (Gondim et al., 2012).

     Systematic reviews evaluating the effect of acupuncture in treating pain have revealed mixed results. Some reviews have found minimal or no effect (Lee et al., 2008; Madsen et al., 2009), while others have found acupuncture to be superior to sham acupuncture and placebo (Berman et al., 1999; White et al., 2007), and still others have concluded that data are insufficient to support a recommendation (Furlan et al., 2005; Paley et al., 2015; Smith et al., 2016a; van Tulder et al., 1999). Recent reviews and meta-analyses examining the effect of acupuncture on musculoskeletal pain (neck and back pain, osteoarthritis, chronic headache and shoulder pain, fibromyalgia) have found that overall, acupuncture is superior to sham and no acupuncture, but with relatively modest differences between true and sham acupuncture (Vickers et al., 2012; Yuan et al., 2016). Although it has been suggested that acupuncture is an effective treatment for pain, additional factors, such as potent placebo and context effects, may play a role in its observed effect as well (Linde et al., 2010a,b; Vickers et al., 2012). It also has been suggested that acupuncture may have value in the treatment of chronic and tension headaches (Linde et al., 2009b; Vickers et al., 2012), as well as in prophylactic treatment for migraine (Linde et al., 2009a). Additional RCTs are needed to determine the effect of acupuncture on neuropathic and postsurgical pain.

     非药物疗法，建议小结

     Page 2-32

     Summary Nonpharmacologic interventions for pain treatment, including acupuncture, physical therapy and exercise, CBT, and mindfulness meditation, represent powerful tools in the management of chronic pain. Many are components of successful self-management. While further research is needed to better understand the mechanism of action and the appropriate dosage and delivery for some nonpharmacologic approaches, they may provide effective pain relief for many patients in place of or in combination with pharmacologic approaches.

     Page 3-34

     Recommendation 3-1. Invest in research to better understand pain and opioid use disorder. Given the significant public health burden of pain and opioid use disorder (OUD) in the United States, the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, the U.S. Department of Veterans Affairs, industry, and other relevant research sponsors should consider greater investment in research on pain and OUD, including but not limited to research aimed at ? improving understanding of the neurobiology of pain; ? developing the evidence on promising pain treatment modalities and supporting the discovery of innovative treatments, including nonaddictive analgesics and nonpharmacologic approaches at the level of the individual patient; and ? improving understanding of the intersection between pain and OUD, including the relationships among use and misuse of opioids, pain, emotional distress, and the brain reward pathway; vulnerability to and assessment of risk for OUD; and how to properly manage pain in individuals with and at risk for OUD.

     政府及保险支付建议

     Page 5-46

     the committee recommends that states, with assistance from relevant federal agencies, particularly the Substance Abuse and Mental Health Services Administration, provide universal access to evidence-based treatment for opioid use disorder (OUD), including use of medication, in a variety of settings, including hospitals, criminal justice settings, and substance use treatment programs. Efforts to this end should be carried out with particular intensity in communities with a high burden of OUD. State licensing bodies should require training in treatment for OUD for all licensed substance use disorder treatment facilities and providers (Recommendation 5-6). The committee recommends that schools for health professional education, professional societies, and state licensing boards require and provide basic training in the treatment of opioid use disorder for health care providers, including but not limited to physicians, nurses, pharmacists, dentists, physician assistants, psychologists, and social workers (Recommendation 5-7). The committee recommends that the U.S. Department of Health and Human Services and state health financing agencies remove impediments to full coverage of medications approved by the U.S. Food and Drug Administration for treatment of opioid use disorder (Recommendation 5-8).

     Page 5-59

     Recommendation 5-3. Facilitate reimbursement for comprehensive pain management. Public and private payers should develop reimbursement models that support evidence-based and cost-effective comprehensive pain management encompassing both pharmacologic and nonpharmacologic treatment modalities.

    

    

    

    点击下方“阅读全文”了解更多资讯

     【纽约中医论坛首发- 纽约博客】

    http://weixin.100md.com
返回 纽约TCM论坛 返回首页 返回百拇医药