Department of Orthopaedic Surgery, Indiana University School of Medicine, 1130 W. Michigan St, FH 115, Indianapolis, IN, 46202, USA.
Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA.
Curr Osteoporos Rep. 2020 Oct;18(5):460-470. doi: 10.1007/s11914-020-00617-z.
Fractures are painful and disabling injuries that can occur due to trauma, especially when compounded with pathologic conditions, such as osteoporosis in older adults. It is well documented that acute pain management plays an integral role in the treatment of orthopedic patients. There is no current therapy available to completely control post-fracture pain that does not interfere with bone healing or have major adverse effects. In this review, we focus on recent advances in the understanding of pain behaviors post-fracture.
We review animal models of bone fracture and the assays that have been developed to assess and quantify spontaneous and evoked pain behaviors, including the two most commonly used assays: dynamic weight bearing and von Frey testing to assess withdrawal from a cutaneous (hindpaw) stimulus. Additionally, we discuss the assessment and quantification of fracture pain in the clinical setting, including the use of numeric pain rating scales, satisfaction with pain relief, and other biopsychosocial factor measurements. We review how pain behaviors in animal models and clinical cases can change with the use of current pain management therapies. We conclude by discussing the use of pain behavioral analyses in assessing potential therapeutic treatment options for addressing acute and chronic fracture pain without compromising fracture healing. There currently is a lack of effective treatment options for fracture pain that reliably relieve pain without potentially interfering with bone healing. Continued development and verification of reliable measurements of fracture pain in both pre-clinical and clinical settings is an essential aspect of continued research into novel analgesic treatments for fracture pain.
骨折是一种疼痛和致残的损伤，可由创伤引起，尤其是在老年人合并病理性骨折时。大量文献证明，急性疼痛管理是骨科患者治疗的重要组成部分。目前尚无一种既能完全控制骨折后疼痛，又不干扰骨愈合或产生重大不良反应的治疗方法。在这篇综述中，我们重点介绍了对骨折后疼痛行为的最新理解进展。
我们回顾了骨骨折的动物模型以及用于评估和量化自发性和诱发性疼痛行为的检测方法，包括最常用的两种检测方法：动态体重支撑和 von Frey 检测，以评估对皮肤（后爪）刺激的回避。此外，我们还讨论了临床环境中骨折疼痛的评估和量化，包括使用数字疼痛评分量表、对疼痛缓解的满意度以及其他生物心理社会因素的测量。我们还讨论了在动物模型和临床病例中，疼痛行为如何随着当前疼痛管理疗法的应用而改变。最后，我们讨论了疼痛行为分析在评估急性和慢性骨折疼痛的潜在治疗选择中的应用，而不会影响骨折愈合。目前，骨折疼痛的有效治疗方法缺乏，既可靠地缓解疼痛，又不会潜在地干扰骨愈合。在临床前和临床环境中持续开发和验证可靠的骨折疼痛测量方法，是继续研究骨折疼痛新型镇痛治疗方法的重要方面。
