对骨质疏松性慢性疼痛:如何认知和预防?

Osteoporotic chronic pain: how to understand and prevent it?

背景:对于骨质疏松症的治疗,临床医师一般只关注骨密度的改善和降低骨折的发生率,却往往忽视与提高患者生活质量密切相关的缓解骨质疏松性慢性疼痛的治疗。目的:就目前国内外有关骨质疏松性慢性疼痛的研究现状做一概述,以期对骨质疏松性慢性疼痛的基础研究和临床治疗有所帮助。方法:应用计算机检索1999年3月至2014年3月万方医学网及PubMed数据库,以"骨质疏松;疼痛;骨质疏松性骨折;经皮椎体成形术"或"Osteoporosis;Chronic pain;Treatment of Osteoporotic;Vertebral Compression Fracture"为检索词进行检索。检索与骨质疏松性慢性疼痛特点、发病机制、药物治疗相关的文献,以及与骨质疏松性椎体压缩性骨折外科治疗相关的文献。最终纳入49篇文章进行分析。结果与结论:骨质疏松慢性疼痛的发病机制有淤血机制,细胞因子和乳酸堆积机制等,但其确切的细胞生化机制尚不十分明确。常用的药物治疗降钙素、二膦酸盐等,降钙素通过抑制骨吸收间接降低氢离子浓度,抑制前列腺素的合成,提高动物痛阈,提高血浆β-内啡肽浓度,而起到镇痛作用。二膦酸盐主要药理作用是抑制破骨细胞生成及其活性,抑制骨吸收,改善骨质疏松性骨痛,显著提高骨密度,增加骨强度,预防骨质疏松性骨折的发生。骨质疏松脊柱压缩性骨折及脊柱良恶性肿瘤采用经皮椎体成形或经皮椎体后凸成形治疗,完全或部分恢复椎体丢失高度,纠正后凸畸形,增加椎体稳定性,缓解疼痛。多种治疗方法联合为骨质疏松慢性疼痛行可行有效的治疗措施,同时,有效防治骨质疏松性骨折的发生对骨质疏松慢性疼痛的防治也具有积极促进作用。

BACKGROUND： For the treatment of osteoporosis, clinicians generally focus on improving bone mineral density and reducing the incidence of fractures, but often ignore the ease of osteoporotic chronic pain. OBJECTIVE： To review the research progress in osteoporotic chronic pain from domestic and overseas literature in recent years in order to provide reference for basic and clinical research. METHODS： Databases of PubMed and Wanfang database were retrieved with key words of ＂osteoporesis; chronic pain; treatment of osteoporotic; vertebral compression fracture＂ in English and Chinese to search papers published from March 1999 to March 2014. Articles related to characteristics, pathogenesis and drug treatment of osteoporotic chronic pain as well as surgical treatment of osteoporotic vertebral compression fractures. Finally 49 articles were summarized according to inclusion criteria. RESULTS AND CONCLUSION： The pathogenesis of osteoporotic chronic pain includes congestion mechanism and mechanisms of cytokines and lactic acid accumulation, but its exact cytological end biochemical mechanisms are not very clear. Commonly used drugs in the treatment of osteoporotic chronic pain include calcitonin andbisphosphonates. Calcitonin plays an analgesic effect by inhibiting bone resorption to indirectly reduce the hydrogen ion concentration, suppress prostaglandin synthesis, improve animal pain threshold, and increase the plasma concentration of beta-endorphin. The main pharmacological action of bisphosphonate is to inhibit osteoclast formation and activity, inhibit bone absorption, improve osteoporetic bone pain, improve bone mineral density, increase bone strength, and prevent osteoporotic fracture. Benign and malignancy tumor of the spine and osteoporotic spinal compression fractures can be treated with percutaneous vertebroplasty or percutaneous kyphoplasty. After treatment, the vertebral height can be restored completely or partially, the kyphosis is corrected, the vertebral stability Is increased and pain is relieved. Combination of various treatments is effective for the treatment of osteoporotic chronic pain, and meanwhile, the prevention and treatment of osteoporetic fractures has a positive role in prevention and treatment of osteoporotic chronic pain.