van Laar Mart, Pergolizzi Joseph V, Mellinghoff Hans-Ulrich, Merchante Ignacio Morón, Nalamachu Srinivas, O'Brien Joanne, Perrot Serge, Raffa Robert B
Arthritis Center Twente (MST & UT), Enschede, The Netherlands.
Open Rheumatol J. 2012;6:320-30. doi: 10.2174/1874312901206010320. Epub 2012 Dec 13.
Managing pain from chronic conditions, such as, but not limited to, osteoarthritis and rheumatoid arthritis, requires the clinician to balance the need for effective analgesia against safety risks associated with analgesic agents. Osteoarthritis and rheumatoid arthritis pain is incompletely understood but involves both nociceptive and non-nociceptive mechanisms, including neuropathic mechanisms. Prevailing guidelines for arthritis-related pain do not differentiate between nociceptive and non-nociceptive pain, sometimes leading to recommendations that do not fully address the nature of pain. NSAIDs are effective in treating the nociceptive arthritis-related pain. However, safety concerns of NSAIDs may cause clinicians to undertreat arthritis-related pain. In this context, combination therapy may be more appropriate to manage the different pain mechanisms involved. A panel convened in November 2010 found that among the currently recommended analgesic products for arthritis-related pain, fixed-low-dose combination products hold promise for pain control because such products allow lower doses of individual agents resulting in decreased toxicity and acceptable efficacy due to synergy between the individual drugs. Better evidence and recommendations are required to improve treatment of chronic arthritis-related pain.
管理慢性疾病(如但不限于骨关节炎和类风湿性关节炎)引起的疼痛,要求临床医生在有效镇痛的需求与镇痛药物相关安全风险之间取得平衡。骨关节炎和类风湿性关节炎疼痛的发病机制尚未完全明确,但涉及伤害性和非伤害性机制,包括神经病理性机制。现行的关节炎相关疼痛指南并未区分伤害性疼痛和非伤害性疼痛,有时会导致一些未能充分解决疼痛本质的建议。非甾体抗炎药(NSAIDs)在治疗与关节炎相关的伤害性疼痛方面有效。然而,NSAIDs的安全性问题可能会导致临床医生对关节炎相关疼痛治疗不足。在此背景下,联合治疗可能更适合处理所涉及的不同疼痛机制。2010年11月召开的一个专家小组发现,在目前推荐用于关节炎相关疼痛的镇痛产品中,固定低剂量复方产品有望控制疼痛,因为这类产品可降低单一药物的剂量,从而降低毒性,并因单一药物之间的协同作用而具有可接受的疗效。需要更好的证据和建议来改善慢性关节炎相关疼痛的治疗。