Acta Reumatol Port. 2020 Jan-Mar;45(1):7-19.
Pain is a common feature of most rheumatic diseases and it is often the main reason for the patient to seek for a clinical appointment. Chronic pain has a major impact on patient's quality of life, being frequently associated with functional incapacity, sleep and mood disorders. This leads to absenteeism and heavy consumption of health resources, both representing huge burdens on national economy. Managing musculoskeletal pain is pivotal but can be challenging. The use of the available pharmaceutical armamentarium should be parsimonious. Opioids are strong analgesic drugs that mostly act through their agonist action on µ-receptors in the central nervous system. Opioid-related side effects are not negligible and are mediated through both central and peripheral opioid receptors. The use of opioids is well established in the treatment of oncologic pain but their role in the management of musculoskeletal pain is still controversial. Inflammatory rheumatic diseases, osteoarthritis, osteoporotic fractures, chronic low back pain and fibromyalgia represent diverse major rheumatic conditions that frequently lead to chronic pain. In order to standardize and optimize management of musculoskeletal chronic pain in these prevalent diseases, the Portuguese Rheumatology Society elaborated this position paper. The objectives were: a) to define the importance of pain assessment and classification; b) to guide patient selection, appropriate choice of opioids, their management, and raise awareness of their adverse effects; c) to review the existent data on possible indications of opioid therapy on rheumatic diseases.
疼痛是大多数风湿性疾病的共同特征，也是患者寻求临床就诊的主要原因。慢性疼痛对患者的生活质量有重大影响，常与功能障碍、睡眠和情绪障碍有关。这导致旷工和大量消耗卫生资源，这两者都给国家经济带来了巨大负担。管理肌肉骨骼疼痛至关重要，但可能具有挑战性。应谨慎使用现有的药物武器库。阿片类药物是一种强效镇痛药，主要通过其在中枢神经系统中µ受体的激动作用发挥作用。阿片类药物相关的副作用不容忽视，并且通过中枢和外周阿片受体介导。阿片类药物在治疗癌痛方面已有良好的应用，但它们在肌肉骨骼疼痛管理中的作用仍存在争议。炎症性风湿病、骨关节炎、骨质疏松性骨折、慢性腰痛和纤维肌痛是常见的主要风湿性疾病，常导致慢性疼痛。为了规范和优化这些常见疾病中肌肉骨骼慢性疼痛的管理，葡萄牙风湿病学会制定了这份立场文件。其目标是：a）定义疼痛评估和分类的重要性；b）指导患者选择、阿片类药物的适当选择、管理，并提高对其不良反应的认识；c）审查阿片类药物治疗风湿性疾病的可能适应症的现有数据。
