Portex Unit: Pain Research and Department of Anaesthesia and Pain Medicine, UCL Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Trust, 30 Guilford St, London WC1N 1EH, UK.
Best Pract Res Clin Rheumatol. 2014 Apr;28(2):213-28. doi: 10.1016/j.berh.2014.03.007.
Pain is a common presenting and often persistent symptom for children with rheumatological disease. Pain is not clearly related to disease severity in children with inflammatory juvenile idiopathic arthritis, and presentations of non-inflammatory musculoskeletal pain are common but there is limited evidence to guide management. Pain assessment must extend beyond measures of pain severity to more fully evaluate characteristics of pain, functional impact and psychosocial effects and family interactions. Evaluation of mechanisms of joint pain in adults has identified potential treatment targets, but additional studies are required as the acute and long-term impacts of pain and injury change during postnatal development. Genotyping, sensory evaluation and neuroimaging may better characterize chronic musculoskeletal pain, identify high-risk groups and/or provide additional outcome measures to monitor disease and treatment progress. An integrated approach to management is required to effectively select and target interventions, reduce pain and disability and improve long-term outcome.
疼痛是儿童风湿性疾病的常见表现，且常持续存在。在患有炎症性幼年特发性关节炎的儿童中，疼痛与疾病严重程度并无明确关系，而非炎症性肌肉骨骼疼痛的表现则很常见，但缺乏指导管理的相关证据。疼痛评估必须超越疼痛严重程度的衡量标准，更全面地评估疼痛的特征、功能影响和心理社会影响以及家庭互动。对成年人关节疼痛机制的评估已经确定了潜在的治疗靶点，但还需要更多的研究，因为疼痛和损伤的急性和长期影响在出生后发育过程中会发生变化。基因分型、感觉评估和神经影像学检查可以更好地描述慢性肌肉骨骼疼痛，确定高风险人群，并/或提供额外的结果衡量标准来监测疾病和治疗进展。需要采取综合管理方法，以有效地选择和针对干预措施，减轻疼痛和残疾，改善长期结果。
