Pain Management after Surgery for Back Pain

治療背痛手術的術後疼痛處理

韓紹禮(Shao-Li Han) ； 張志儒(Chih-Ju Chang) ； 林希鼎(Hsi-Ting Lin)

《疼痛醫學雜誌》 24卷2期 (2014/09) Pp. 54-64

摘要

手術後疼痛的處理，是背痛的手術的重要一環，而目前術後疼痛處理仍顯不足。處理術後疼痛，有助於術後的恢復。排除手術併發症等問題後，有許多方式可降低術後的疼痛。近幾年的研究顯示，已有其他的方式證實可作為藥物治療的輔助方式。背痛手術會造成中度到嚴重的疼痛，但手術後是可以盡早活動的。此外，除了病患自控式止痛法外，仍可單獨或者搭配其他的藥物使用。這些藥物藉由不同的給藥路徑，同時給予病患，以達降低術後疼痛的效果。這就是「多模式止痛」，可以降低鴉片類藥物的副作用、縮短的住院時間。復健計畫、治療儀器的使用、針刺治療、按摩等，對於術後疼痛都可能有幫助。復健計畫應在手術前就開始啟動，而物理治療儀器有助於降低術後的疼痛。另外，術前提供病患足夠疼痛的訊息，可以降低病患的焦慮及疼痛感。關於術後疼痛的資訊，護理師是最常見的來源。因此，多模式止痛以及多專業領域的介入，可以有效降低背痛病患術後的疼痛。

關鍵字

背痛 ； 術後癢痛 ； 多模式治療 ； 復健 ； 物理治療儀器

並列摘要

Postoperative pain management is essential for a successful back surgery. However, insufficient postoperative pain management remains a problem in spite of the publication of several guidelines. After excluding surgical complications, several methods have been shown to relieve pain successfully after back pain surgery. Administration of drugs is an effective method to relieve postsurgical pain, but several other methods have proved efficient for postoperative pain control. Local analgesia, early mobilization, physical agents, and topical application of analgesics for postoperative pain have apparently been proved as supplemental therapies for postoperative pain. Proper application and combination of these methods can facilitate patient recovery and reduce postoperative pain. A structured preoperative and postoperative rehabilitation program, physical agents, acupuncture, and massage may be also helpful. In addition, adequate information about pain management before surgery may also reduce postsurgical pain. Nurses may be the most common source of postsurgical information. Therefore, multimodal analgesia and multidisciplinary intervention may be effective and safe ways to relieve postoperative pain after back surgery.

並列關鍵字

back pain ； postoperative pain ； multimodal treatment ； rehabilitation ； physical therapy modality