J Am Acad Orthop Surg. 2014 Feb;22(2):101-10. doi: 10.5435/JAAOS-22-02-101.
Chronic musculoskeletal pain results from a complex interplay of mechanical, biochemical, psychological, and social factors. Effective management is markedly different from that of acute musculoskeletal pain. Understanding the physiology of pain transmission, modulation, and perception is crucial for effective management. Pharmacologic and nonpharmacologic therapies such as psychotherapy and biofeedback exercises can be used to manage chronic pain. Evidence-based treatment recommendations have been made for chronic pain conditions frequently encountered by orthopaedic surgeons, including low back, osteoarthritic, posttraumatic, and neuropathic pain. Extended-release tramadol; select tricyclic antidepressants, serotonin reuptake inhibitors, and anticonvulsants; and topical medications such as lidocaine, diclofenac, and capsaicin are among the most effective treatments. However, drug efficacy varies significantly by indication. Orthopaedic surgeons should be familiar with the widely available safe and effective nonnarcotic options for chronic musculoskeletal pain.
慢性肌肉骨骼疼痛是由机械、生化、心理和社会因素的复杂相互作用引起的。有效管理与急性肌肉骨骼疼痛明显不同。了解疼痛传递、调节和感知的生理学对于有效管理至关重要。可以使用药理学和非药理学疗法，如心理治疗和生物反馈练习来管理慢性疼痛。已经为骨科医生经常遇到的慢性疼痛病症提出了循证治疗建议，包括下腰痛、骨关节炎、创伤后和神经性疼痛。延胡索乙素；选择性三环类抗抑郁药、5-羟色胺再摄取抑制剂和抗惊厥药；以及局部药物如利多卡因、双氯芬酸和辣椒素是最有效的治疗方法之一。然而，药物的疗效因适应症而异。骨科医生应该熟悉广泛可用的安全有效的非麻醉性慢性肌肉骨骼疼痛选择。
