慢性原发性疼痛临床管理精神卫生领域专家共识

中华精神科杂志2023年4月第56卷第2期Chin JPsychiatry,Apil2023,Vd.56,No.2·89·标准与讨论·慢性原发性疼痛临床管理精神卫生领域专家共识中国医师协会精神科医师分会中国医师协会疼痛科医师分会中国麻醉药品协会精神卫生分会中国药物滥用防治协会上海市医学会精神医学专科分会上海市医学会疼痛学专科分会通信作者：赵敏，Email:drminzhao@smhc.org.cn【摘要】慢性原发性疼痛(chronic primar町y 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1I版(International Classification of Diseases1 1th RevisionICD-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。【关键词】精神卫生；慢性原发性疼痛：专家共识基金项目：上海市医学重点专科建设计划(ZK2019A06):上海市精神心理疾病临床医学研究中心(19MC1911100):上海市卫生健康委员会科研课题(202040318)；上海市科技创新行动计划(21DZ2201000)Expert consensus on clinical management of chronic primary pain in the field of mentalhealthChinese Psychiatrist Association,Pain Physician Branch of Chinese Medical Doctor Association,MentalHealth Branch of China National Narcotic Drugs Association,Chinese Association of Drug AbusePrevention and Treatment,Psychiatric Medicine Branch of Shanghai Medical Association,PainPhysician Branch of Shanghai Medical AssociationCorresponding author:Zhao Min,Email:drminzhao@smhc.org.cnAbstract Chronic primary pain (CPP),a critical public health problem,seriously affectspatients'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 graduallyattracted the public attrention.Most CPP patients also experience emotional symptoms such asanxiety,frustration,and depression.However,the current CPP clinical practice guidelines and expertconsensus mainly focus on treating pain symptoms,and there is still a lack of guidance on relevantemotional symptoms.Under the principle of evidence-based medicine,this expert consensus gradedthe recommendations and levels of evidence.Under the guidance of the principles ofevidenced-based medicine,this expert consensus grades the evidence level and recommendation forcommonly used psychiatric treatment measures,among which antidepressants,repetitivetranscranial magnetic stimulation (rTMS),transcranial direct current stimulation (tDCS)andcognitive behavioral therapy (CBT)are all ranked as 1A.This consensus provides evidence supportto standardize the diagnosis and treatment of CPP.Key words Mental health;Chronic primary pain;Expert consensusD01:10.3760/cma.j.cm113661-20220820-00226收稿日期2022-08-20本文编辑常静引用本文：中国医师协会精神科医师分会，中国医师协会疼痛科医师分会，中国麻醉药品协会精神卫生分会，等.慢性原发性疼痛临床管理精神卫生领域专家共.中华精神科杂志，2023,56(289-97.D01:10.3760cma.j.cml13661-20220820-00226.