Perrot S, Menkes C J
Service de Rhumatologie A, Hôpital Cochin, Paris, France.
Drugs. 1996;52 Suppl 3:21-6. doi: 10.2165/00003495-199600523-00005.
Many treatments or techniques have been developed to combat pain in osteoarthritis. These can reduce drug consumption and toxicity, or even delay the need for joint replacement surgery. Pain management in osteoarthritis should start with education, psychological support and environmental measures, reassuring patients that such pain is a reversible state, not associated with aging and irreversible loss of ability. Physiotherapy and exercises are very important for maintaining muscle strength, joint stability and mobility, but should be closely monitored for optimal efficacy. Splints and weight reduction in the obese are useful, depending on the joints involved. Preventive surgery such as cruciate ligament repair or osteotomy should be considered for cases with moderate osteoarthritis. Intraarticular lavage is effective in the short term, and the effectiveness is increased with the use of an arthroscope when meniscus tears or cartilage fragments are associated with osteoarthritis. Nonconventional therapies such as homeopathy, acupuncture and transcutaneous electrical nerve stimulation can be tried at all stages; even if not really efficient, most of these techniques are usually innocuous. Doctors should be aware of these neglected techniques for a better, well tolerated and cost-effective management of pain associated with osteoarthritis.
已经开发出许多治疗方法或技术来对抗骨关节炎疼痛。这些方法可以减少药物消耗和毒性，甚至推迟关节置换手术的需求。骨关节炎的疼痛管理应从教育、心理支持和环境措施开始，让患者放心，这种疼痛是一种可逆状态，与衰老和不可逆转的能力丧失无关。物理治疗和锻炼对于维持肌肉力量、关节稳定性和活动能力非常重要，但应密切监测以获得最佳疗效。根据受累关节的情况，夹板固定和肥胖者减轻体重是有用的。对于中度骨关节炎病例，应考虑进行预防性手术，如十字韧带修复或截骨术。关节内灌洗在短期内有效，当半月板撕裂或软骨碎片与骨关节炎相关时，使用关节镜可提高其有效性。顺势疗法、针灸和经皮电刺激神经等非常规疗法在各个阶段都可以尝试；即使不是真的有效，这些技术中的大多数通常也是无害的。医生应该了解这些被忽视的技术，以便更好地、耐受性良好且经济高效地管理与骨关节炎相关的疼痛。
