Sherry D D
Pediatric Rheumatology Section, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA.
J Rheumatol Suppl. 2000 Apr;58:44-8.
Children may have a wide variety of amplified musculoskeletal pain syndromes that may or may not be associated with overt autonomic signs and may be diffuse or localized to one body part. It is most common in pre- to adolescent girls. Hallmarks of the diagnosis include increasing pain over time, allodynia, an incongruent affect, disproportional dysfunction, and the absence of other causes. Psychological distress within the child or family is apparent in most, but not all, since it also is associated with injury or illness. Once the diagnosis is established, all medicines and testing are stopped. A sympathetically driven pain model is used to explain the pain to make it understandable. Treatment is an intense exercise program; ours is 5 hours daily. We focus on functional aerobic training specifically using the involved body part such as sports related drills, running, play activities, and swimming. Allodynia is treated with desensitization such as towel rubbing. A psychological evaluation is done and specific psychotherapy is recommended if indicated. The average duration of the daily program is 2 weeks with a 1 hour home program being done for another 2 to 8 weeks. After one month roughly 80% of the children have no pain and are fully functional, another 15% are fully functional with mild or recurrent pain; 5% are not better. Significant relapses are infrequent; 15% require retreatment. Five to 10% of the children will develop a different symptom of psychological distress. At 5 years, 90% are doing well.
儿童可能患有多种广泛性肌肉骨骼疼痛综合征，这些综合征可能与明显的自主神经症状有关，也可能无关，疼痛可能是弥漫性的，也可能局限于身体的某个部位。这种情况在青春期前至青春期的女孩中最为常见。诊断的标志包括疼痛随时间加重、痛觉过敏、情感不协调、功能障碍不成比例以及无其他病因。大多数（但并非所有）患儿或其家庭存在心理困扰，因为这也与受伤或疾病有关。一旦确诊，应停用所有药物并停止检查。采用交感神经驱动的疼痛模型来解释疼痛，使其易于理解。治疗方法是强化运动计划；我们的计划是每天5小时。我们专注于功能性有氧训练，具体使用受累身体部位，如与运动相关的训练、跑步、游戏活动和游泳。通过毛巾擦拭等脱敏方法治疗痛觉过敏。进行心理评估，如有必要，建议进行特定的心理治疗。每日计划的平均时长为2周，之后还要进行2至8周、每次1小时的家庭训练计划。大约一个月后，80%的儿童不再疼痛且功能完全恢复，另外15%功能完全恢复，但仍有轻度或复发性疼痛；5%的儿童病情未见好转。显著复发情况不常见；15%的儿童需要再次治疗。5%至10%的儿童会出现不同的心理困扰症状。5年后，90%的儿童情况良好。
