Huang Yun-Ting, McCarthy Craig, Jani Meghna
Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom.
NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom.
Front Drug Saf Regul. 2023 Feb 16;3:1117674. doi: 10.3389/fdsfr.2023.1117674. eCollection 2023.
Pain management has been a challenging issue for people living with rheumatic and musculoskeletal diseases (RMDs) and health professionals for decades. Pharmacological treatments remain a core element of pain management of inflammatory arthritis and osteoarthritis. Yet balancing the benefits/harms in pain management within RMDs can be difficult to navigate due to limited effective options, and emerging adverse events in a population where individual risk is important to consider due to patient multimorbidity, immunosuppression and polypharmacy. Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) analgesics are widely used among RMD patients, however both classes of drugs have been associated with new safety concerns in the last two decades. Perhaps as a result in combination with multifactorial influences, opioid prescribing has increased from the 2000s-2010s in the majority of RMD focussed studies, accompanied with a rising trend of long-term opioid use, despite limited evidence on efficacy. Gabapentinoids have also shown increasing trends more recently, despite an unclear role in chronic pain management for RMDs within current guidelines. Antidepressants are recommended as the first line of pharmacological treatment of chronic primary pain (e.g., fibromyalgia) by the latest National Institute for Health and Care Excellence (NICE) guideline released in April 2021. This concise narrative review will discuss pharmacological options for pain management, based on the latest evidence that includes the main analgesic drug classes: paracetamol, NSAIDs, opioids, antidepressants, and gabapentinoids. We will discuss the efficacy of these analgesics in RMDs and emerging safety concerns to enable more informed shared decisions with patients commencing such medications.
几十年来，疼痛管理一直是风湿性和肌肉骨骼疾病（RMD）患者及医疗专业人员面临的一个具有挑战性的问题。药物治疗仍然是炎症性关节炎和骨关节炎疼痛管理的核心要素。然而，由于有效选择有限，以及在一个因患者多种合并症、免疫抑制和联合用药而需要考虑个体风险的人群中出现新的不良事件，在RMD的疼痛管理中平衡获益/危害可能很难把握。对乙酰氨基酚和非甾体抗炎药（NSAIDs）类镇痛药在RMD患者中广泛使用，然而在过去二十年中，这两类药物都出现了新的安全问题。也许是多种因素综合影响的结果，在大多数以RMD为重点的研究中，阿片类药物的处方量自21世纪初至21世纪10年代有所增加，尽管疗效证据有限，但长期使用阿片类药物的趋势仍在上升。加巴喷丁类药物最近也呈上升趋势，尽管在目前的指南中，其在RMD慢性疼痛管理中的作用尚不清楚。2021年4月发布的最新英国国家卫生与临床优化研究所（NICE）指南推荐抗抑郁药作为慢性原发性疼痛（如纤维肌痛）的一线药物治疗。这篇简明的叙述性综述将基于最新证据讨论疼痛管理的药物选择，这些证据包括主要的镇痛药类别：对乙酰氨基酚、NSAIDs、阿片类药物、抗抑郁药和加巴喷丁类药物。我们将讨论这些镇痛药在RMD中的疗效以及新出现的安全问题，以便与开始使用此类药物的患者做出更明智的共同决策。
