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大师班:肌肉骨骼疾病患者疼痛敏感性的实用方法及其对肌肉骨骼临床医生临床管理的影响。

Masterclass: A pragmatic approach to pain sensitivity in people with musculoskeletal disorders and implications for clinical management for musculoskeletal clinicians.

机构信息

School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Pain Options, 7 Hardy Street, South Perth, Western Australia, 6151, Australia.

School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Pain Options, 7 Hardy Street, South Perth, Western Australia, 6151, Australia.

出版信息

Musculoskelet Sci Pract. 2021 Feb;51:102221. doi: 10.1016/j.msksp.2020.102221. Epub 2020 Jul 18.

Abstract

INTRODUCTION

Research on musculoskeletal disorders indicates that pain sensitivity can be an important consideration for musculoskeletal clinicians in the holistic view of a patient presentation. However, diversity in research findings in this field can make this a difficult concept for clinicians to navigate. Limited integration of the concept of pain sensitivity into clinical practice for musculoskeletal clinicians has been noted.

PURPOSE

The purpose of this masterclass is to provide a framework for the consideration of pain sensitivity as a contributing factor in the presentation of people with musculoskeletal pain. It provides pragmatic synthesis of the literature related to pain sensitivity through a lens of how this information can inform clinical practice for musculoskeletal clinicians. Guidance is provided in a 'how to' format for integration of this knowledge into the clinical encounter to facilitate personalised care.

IMPLICATIONS

The relationship of pain sensitivity with pain and disability is not clear or linear. The real importance of pain sensitivity in a clinical presentation may be: (1) the potential for pain sensitivity to modify the effect of common treatments utilised by musculoskeletal clinicians, or (2) the effect of pain sensitivity on the prognosis/course of a disorder. Screening tools and subjective features have been highlighted to indicate when physical assessment of pain sensitivity should be prioritised in the physical examination. A pragmatic blueprint for specific assessment related to pain sensitivity has been outlined. A framework for integrating assessment findings into clinical reasoning to formulate management plans for the pain sensitive patient is provided.

摘要

简介

肌肉骨骼疾病的研究表明,疼痛敏感性可以作为肌肉骨骼临床医生整体患者表现的重要考虑因素。然而,该领域的研究结果存在差异,使得临床医生难以理解这个概念。将疼痛敏感性的概念有限地整合到肌肉骨骼临床医生的临床实践中已经得到了注意。

目的

本大师班旨在为将疼痛敏感性作为肌肉骨骼疼痛患者表现的一个影响因素纳入考虑提供一个框架。通过关注这些信息如何为肌肉骨骼临床医生的临床实践提供信息,对与疼痛敏感性相关的文献进行了实用的综合。以“如何”的形式提供了将这些知识融入临床接触以促进个性化护理的指导。

影响

疼痛敏感性与疼痛和残疾之间的关系并不明确或线性。疼痛敏感性在临床表现中的真正重要性可能是:(1)疼痛敏感性有可能改变肌肉骨骼临床医生常用的常见治疗的效果,或(2)疼痛敏感性对疾病的预后/病程的影响。已经强调了筛选工具和主观特征,以指示在体格检查中何时应优先进行疼痛敏感性的体格评估。已经概述了与疼痛敏感性相关的具体评估的实用蓝图。提供了一个将评估结果纳入临床推理的框架,为疼痛敏感患者制定管理计划。

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