一种基于机制的骨关节炎疼痛管理方法。
A Mechanism-Based Approach to the Management of Osteoarthritis Pain.
作者信息
Cohen Ezra, Lee Yvonne C
机构信息
Department of Rheumatology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
Department of Rheumatology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
出版信息
Curr Osteoporos Rep. 2015 Dec;13(6):399-406. doi: 10.1007/s11914-015-0291-y.
Pain from osteoarthritis (OA) affects millions of people worldwide, yet treatments are limited to acetaminophen, NSAIDs, physical therapy, and ultimately, surgery when there is significant disability. In recent years, our understanding of pain pathways in OA has developed considerably. Though joint damage and inflammation play a significant role in pain generation, it is now understood that both central and peripheral nervous system mechanisms exacerbate symptoms. Evolving management strategies for OA address central factors (e.g., sleep difficulties, catastrophizing, and depression) with treatments such as cognitive behavioral therapy and exercise. In addition, emerging data suggest that antibodies against peripheral signaling neuropeptides, such as nerve growth factor-1 (NGF-1), may significantly alleviate pain. However, concerns regarding potential adverse effects, such as rapidly progressive OA, still remain. A nuanced understanding is essential if we are to make headway in developing more effective treatments for OA.
骨关节炎（OA）引发的疼痛影响着全球数百万人，然而其治疗方法仅限于对乙酰氨基酚、非甾体抗炎药、物理治疗，最终在出现严重残疾时进行手术。近年来，我们对OA疼痛通路的理解有了很大进展。尽管关节损伤和炎症在疼痛产生中起重要作用，但现在人们认识到中枢和外周神经系统机制都会加重症状。OA不断发展的管理策略通过认知行为疗法和运动等治疗方法来解决中枢因素（如睡眠困难、灾难化思维和抑郁）。此外，新出现的数据表明，针对外周信号神经肽（如神经生长因子-1，NGF-1）的抗体可能会显著减轻疼痛。然而，对于潜在不良反应（如快速进展性OA）的担忧仍然存在。如果我们要在开发更有效的OA治疗方法方面取得进展，细致入微的理解至关重要。
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