肌肉骨骼慢性疼痛诊治专家共识

肌肉骨骼系统慢性疼痛是临床最常见的慢性疼痛。随着人口老龄化,慢性肌肉骨骼疼痛的总体负担将继续加重,对安全有效的疼痛管理的需求也将日益增加。由于文化、经济和监管因素不同,国际指南可能不完全适合中国病人。可用的国内指南大多只针对于药物治疗,且没有阐述中医药在肌肉骨骼系统慢性疼痛诊治中的重要作用。为了制定慢性肌肉骨骼疼痛的中西医结合专家共识,我们召开会议回顾并讨论近期循证医学证据、临床经验和我们目前面临的实践挑战,为慢性肌肉骨骼疼痛的全面评估和管理提供了建议。这些共识建议不是指令性的,而是作为临床实践决策的指南,慢性肌肉骨骼疼痛的最佳治疗方案应该是个性化的。     

骨性关节炎所致慢性持续性疼痛的发病机制

在世界范围内,骨关节炎(osteoarthritis,OA)已成为引起肌肉骨骼疼痛和功能残疾的主要病因。尽管临床上已使用多种保守或介入治疗方法,但是仍不能有效控制OA所致的疼痛。各种原因引起的慢性疼痛特别是神经病理性疼痛是最具挑战的临床医疗和公众健康问题,给患者及其家庭乃至社会带来沉重的精神和经济负担。慢性疼痛治疗手段繁多但疗效却并不满意,究其原因主要是对慢性疼痛的发生发展机制认识尚不足,且已知的科研成果尚未转化为临床治疗手段。本文旨在综述OA所致慢性疼痛的潜在病理生理机制,以期探讨新的有效控制OA痛的作用靶点,对新药研发及新的治疗策略提供思路。     

第四届"奇正杯"消痛贴膏临床应用有奖征文通知

<正>藏医药历史源远流长、博大精深,是我国民族医学宝藏。奇正藏药公司生产的奇正消痛贴膏上市二十余年来,临床疗效显著,受到广大医生及患者的信任和好评。为提高临床脊柱脊髓慢性疼痛相关疾病的诊疗水平,推动镇痛药物的合理应用,促进我国民族医药发展,更好地发挥藏药在骨骼肌肉慢性疼痛治疗中的作用,《中国脊柱脊髓杂志》携手中国藏药领导者     

护士职业性肌肉骨骼疾患的危险因素及防护对策

对护士职业性肌肉骨骼疾患的危险因素及防护对策进行综述.护士职业性肌肉骨骼疾患具有发病率高、复发率高、好发部位不一、临床表现多样的特点;其危险因素包括职业因素(工作负荷、静态负荷、反复操作)、心理社会因素、个体因素等.提出护理管理者及临床护士需提高对职业性肌肉骨骼疾患的认识,从已知的危险因素入手进行积极综合防护,以降低护士职业性肌肉骨骼疾患的发生、发展.     

下肢静脉超声检出肌肉骨骼系统病变的临床价值

目的探讨下肢静脉超声检出肌肉骨骼系统病变的临床价值。方法回顾性收集因临床疑诊或需除外下肢深静脉血栓接受下肢静脉超声检查的8 288例患者的资料,分析下肢静脉超声检查对于肌肉骨骼系统病变的检出率及合并深静脉血栓等超声表现。结果下肢静脉超声检出肌肉骨骼系统病变134例,以腘窝囊肿(90/134,67.16%)最常见,其后依次为血肿(31/134,23.13%)、肌肉撕裂(5/134,3.73%)、脓肿(2/134,1.49%)、肿瘤(2/134,1.49%)、肌层囊肿(2/134,1.49%)、腘窝术后积液(1/134,0.75%)及膝关节滑膜增生(1/134,0.75%)。不同肌肉骨骼系统病变超声表现各异。腘窝未破裂囊肿最大径大于破裂囊肿(F=5.266,P=0.024)。134例中20例合并下肢深静脉血栓,其中肌肉撕裂患者最易合并血栓(1/5,20.00%)。结论下肢静脉超声检查可在判别有无深静脉血栓的同时检出肌肉骨骼系统病变,有助于修正或补充临床诊断及治疗方案,具有较高临床价值。     

《肌肉骨骼系统的超声检查》（DVD）征订消息

《肌肉骨骼系统的超声检查》由北京大学第三临床学院超声诊断科王金锐和崔立刚教授主讲。本教材根据肌肉骨骼系统超声检查临床适应证、检查方法、肌肉骨骼系统解剖结构、常见病变的声像图表现,系统阐述了超声在肩关节、肘关节、腕关节、髋关节、膝关节、踝关节及肌肉系统中的应用。由于肌肉骨骼系统超声检查     

骨关节炎合并情绪障碍及植物神经功能紊乱的临床研究进展

骨关节炎为常见的肌肉骨骼疾病,是导致疼痛和残疾的重要原因之一.大部分骨关节炎患者长期存在慢性疼痛,会逐渐产生焦虑、抑郁等情绪障碍,而情绪障碍又会引发植物神经功能紊乱,进一步加重了患者的疼痛感受和临床症状,在不同程度上降低了临床治疗效果,继而导致患者的心理问题加重,产生恶性循环.近年来,临床医生开始关注骨关节炎合并因情绪...     

“2014‘我最享亮’优秀临床经验分享征文评选”活动总决赛在杭州完满落幕

为提高临床相关疾病的诊疗水平,推动规范合理的镇痛治疗方案在临床的应用,鼓励临床医生对骨骼肌肉相关性疾病开展临床经验分享。在全国各地通过各医院科室启动、临床经验收集、区域选拔赛、半决赛和全国总决赛等几个阶段如火如荼的活动开展,反响热烈,掀起一阵又一阵的学术热潮!活动举办期间,共有超过5000名的医生参与了活动,征集到的优秀临床经验逾1000份。临床医师就骨骼肌肉疼痛疾病     

现代肌肉骨骼系统肿瘤诊断与治疗高级研修班通知

经中华医学会批准,北京积水潭医院拟于２０００年７月２１～２３日在北京举办现代肌肉骨骼系统肿瘤诊断与治疗高级研修班。美国著名的骨肿瘤先驱ＥｎｎｅｋｉｎｇＷＦ等三位教授将来华就肌肉骨骼系统的肿瘤外科分期、保肢外科治疗的功能评定系统及骨肿瘤临床治疗经验等有关问题进行专题讲座,将采用讲座与多媒体影像相结合的方式进行教学。学员要求具有骨肿瘤诊治经验、主治医师以上水平的临床和病理医师。联系人:北京积水潭医院骨肿瘤科牛晓辉、张清。邮政编码:１０００３５。电话:（０１０）６６１６７６３１-６４４２。Ｆａｘ:（０１０）…     

肌肉、骨骼与骨质疏松专家共识

骨质疏松症已成为全球性的公共健康问题和前沿研究难题。老年人骨骼肌肉系统的衰退会造成肌肉萎缩、骨质减少,进而引起肌力减退、运动能力、平衡能力下降、步行缓慢、骨脆性增大、易骨折,最终导致老年人生活质量下降。如何从肌肉、骨骼方面研究其与骨质疏松的关系非常迫切和重要。为此,中国老年学学会骨质疏松委员会成立了肌肉、骨骼与骨质疏松学科组,组织专家编写《肌肉、骨骼与骨质疏松专家共识》,为骨质疏松症的临床诊疗和科学研究提供参考。共识认为:骨质疏松与肌肉、骨骼密切相关。骨质疏松症和肌少症存在着很多共同的风险因素。肌骨代谢生化指标可反映肌骨代谢状态,对代谢性肌肉骨骼疾病的诊断和疗效评价有指导作用。推荐使用DXA测量肌肉质量和骨密度。肌力和平衡能力评定有助于判断跌倒风险。肌肉、骨骼存在潜在的药物作用共同靶点。肌肉骨骼运动可以增加峰值骨量,调节骨代谢信号通路,促进骨形成。骨质疏松人群应注重个体化运动锻炼。中医学认为肌肉、骨骼与脾、肝、肾关系密切,骨质疏松症的病位主要在肾、脾、经络,主要与肾虚、脾虚和血瘀有关,强调骨筋肉并重,动静结合,治疗原则宜补肾、健脾、活血。     

Illness‐related complaints in women with chronic widespread pain: importance of a contextual approach

The study, comprising 125 sick‐listed women aged 25–64 (m = 46.9 years) with widespread chronic pain, aimed at evaluating biopsychosocial problems as perceived by these women, studying such problems within a contextual framework, relating the findings to sociodemographic and medical data. Musculoskeletal complaints, fatigue, inability to work, sleep disturbances and uncertainty about the future were the problems, other than pain, most frequently reported. The women's written accounts of their musculoskeletal or somatic problems reflected being troubled by their unpaid household work and duties. Their psychological symptoms and social problems generally concerned paid work, unemployment or being on sick leave. The women's biomedical orientation appeared to be a function of their extended pharmaceutical and surgical treatment and their efforts to be recognized, particularly by insurance authorities, as clearly having a somatic disease. The study indicates the importance of a situational approach to gaining an understanding of illnesses in women with widespread pain. It is argued that, in a society accepting only medical grounds for sicklisting, physicians and other health care workers serve to reinforce a biomedical perspective in women suffering from biomedically ‘unexplained’ somatic symtoms, tending to result in medicalization, surgery and heavy use of pharmaceutical drugs. Copyright © 2005 John Wiley & Sons, Ltd.     

Analgesic and psychoactive drugs in the chronic pain patient

In contrast to the management of pain in patients with malignant disease, where manipulation of analgesic and psychoactive drugs may be necessary and effective, the elimination of drug use is a primary goal in programs for patients with chronic pain of benign rig in.; Drug use is often a significant component of pain behavior and, therefore, it is important to alter the use of drugs in freeing the patient of the chronic pain syndrome. Elimination of the unwanted side effects and medical complications of drug use may contribute significantly to the patient's physical and psychological well-being. Also, because many of these drugs are associated with physiological or psychological dependency, it also becomes important to identify and treat drug abuse and chemical dependency, which is a primary problem in a subgroup of chronic pain patients. This discussion will focus on the relationship of drug use to chronic pain behavior and methods of medication withdrawal. In addition, the problems of chemical dependency and its identification and management will be discussed.J Orthop Sports Phys Ther 1984;5(6):315-317.     

Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 1: The mechanisms

This article reviews and discusses the biological and psychological mechanisms that may be responsible for therapeutic effect in an osteopathic therapeutic encounter. Although many of the reviewed mechanisms require additional high-quality evidence, osteopathic treatment may reduce pain and improve movement and function from a ‘bottom-up’ influence on tissues and tissue receptors and from a ‘top-down’ influence on cognitive and psychological states. Osteopathic models and manipulative technique have traditionally emphasized tissue and biomechanical mechanisms, but this emphasis is misplaced given the paucity of clinical evidence for these effects. In recent decades, growing evidence supports the importance of neurological and psychosocial factors in musculoskeletal pain, making the ‘biopsychosocial’ model of pain management a mainstream consideration for the management of pain. This article proposes that both biological and psychosocial therapeutic mechanisms may contribute to therapeutic effect and that tissue and neurological effects on pain and motion, albeit small and temporary, may complement cognitive reassurance and education to promote improved confidence and control in movement. Judgement of the dominating factors will help determine the clinical approach. Part 2 will explore the clinical approaches that arise from an understanding of the mechanisms likely involved in manual therapy.     

Complementary and Alternative Modalities (CAM) for pain management in musculoskeletal diseases (MSDs)

Musculoskeletal diseases are a group of clinical conditions affecting the body's movement and remain a common source of pain affecting the quality of life. The aetio-pathological reasons for pain associated with musculoskeletal diseases can be varied and complex. Conventional medicine can treat or modify pain due to musculoskeletal diseases; however, these may be associated with some side effects and at times may not be able to relieve pain completely. These treatment modalities also have ceiling effects like doses of analgesics, the number of nerve blocks, etc. Complementary and Alternative Medicine (CAM) provides a supplementary, unconventional modality to alleviate discomfort and disability associated with these mostly chronic conditions to manage activities of daily living. These modalities have been variedly combined with conventional management for symptom control and thus improve day-to-day activities. We assess the role of commonly used CAM modalities in the management of pain arising from Musculoskeletal diseases.     

An update on the management of chronic pelvic pain in women

Chronic pelvic pain represents a major public health problem for women and impacts significantly on their quality of life. Yet it is under-researched and a challenge to manage. Women who suffer from chronic pelvic pain frequently describe their healthcare journey as long, via a variety of specialists and frustrating, with their pain often dismissed. Aetiological factors and associations are best conceptualised using the ‘three P’s’ model of predisposing, precipitating and perpetuating factors. This integrates the numerous biological, psychological and social contributors to the complex, multifactorial nature of chronic pelvic pain. Overall management involves analgesia, hormonal therapies, physiotherapy, psychological approaches and lifestyle advice, which like other chronic pain conditions relies on a multidisciplinary team approach delivered by professionals experienced and trained in managing chronic pelvic pain.     

The significance of the sleeping-waking brain for the understanding of widespread musculoskeletal pain and fatigue in fibromyalgia syndrome and allied syndromes

The clinical focus of rheumatologists on the widespread pain and numerous tender points in specific anatomic regions in their patients who show no evidence for disease pathology has lead to the characterization of such peripheral symptoms as a specific disorder of the musculoskeletal system, now commonly known as fibromyalgia. This rheumatologic diagnostic entity has resulted in relative inattention to an understanding of their patients' common complaints of unrefreshing sleep, chronic fatigue and psychological distress. Experimental evidence from humans and animal studies indicate that there is an inter-relationship of disturbances in the physiology of the sleeping-waking brain with the widespread musculoskeletal pain, chronic fatigue, and psychological distress in patients with hitherto unexplained pain/fatigue illnesses, e.g., fibromyalgia and chronic fatigue syndromes. The emerging knowledge of the dysfunction of the nervous system in such patients has lead to the study of novel medications that affect neurotransmitter functions, e.g., pregabalin, serotonin/noradrenaline compounds and sodium oxybate that are shown to improve many of the symptoms of such patients.     

影响植入性鞘内药物输注系统治疗慢性疼痛疗效的研究进展

背景 应用植入性药物输注系统(implantable drug delivery systems,IDDS)是目前治疗慢性难治性疼痛的有效方法之一.然而临床应用中并非所有患者都能取得良好疗效. 目的 总结国内外近期关于慢性疼痛患者IDDS镇痛治疗影响因素的研究,为临床实践提供解决问题的思路和方法. 内容 选择合适的患者、镇痛药物以及良好的管理是获得良好效果的基础.导管尖端的位置取决于患者的疼痛平面,药物的选择主要取决于疼痛的性质,药物的半衰期、输注模式、手术因素以及患者及其家庭等多种因素也均影响IDDS镇痛的疗效. 趋向 对于慢性难治性疼痛,疼痛三阶梯治疗并不能完全有效镇痛,采用IDDS将是慢性难治性疼痛治疗不可替代的方法之一.随着对脑脊液药代动力学的不断认识,鞘内新药物的不断发展和原有药物剂型的改进,优化围手术期管理,IDDS的临床效果将与时俱进.