腰椎小关节骨关节炎的疼痛管理与药物治疗进展

Research progress in pain management and pharmacological treatment for lumbar facet joint osteoarthritis

腰椎小关节骨关节炎是慢性腰痛的常见病因,在老年人中普遍存在。腰椎小关节退行性病变产生的组织损伤和炎症会引起多种炎性介质的释放,刺激神经末梢引起疼痛。药物治疗是腰椎小关节骨关节炎疼痛治疗的重要基石,贯穿患者整个病程。总体来说,腰椎小关节骨关节炎的疼痛治疗应遵循阶梯化与个体化原则,根据实际情况选择合适的治疗方案。非甾体类抗炎药是临床常用的一线治疗药物,因外用贴剂与口服片剂疗效相当且安全性更优,被多个指南推荐作为骨关节炎患者首选药物。对乙酰氨基酚仅推荐用于短期治疗或辅助治疗,阿片类药物因具有安全性风险及成瘾性,临床应用应谨慎。

Lumbar facet joint osteoarthritis(FJOA)is the cause of chronic low back pain and is prevalent in elderly.Tissue damage and inflammation resulting from degenerative lumbar facet joints can cause the release of inflammatory factors that stimulate teleneuron and cause pain.Drug therapy lays foundation of the pain management of FJOA,and should be maintained in the whole disease course.In general,the principles of step and individual pain care are recommended for the treatment of FJOA.Patients could choose the appropriate treatment plan according to the actual situation.Non-steroidal anti-inflammatory drugs(NSAIDs)are commonly used as first-line treatment drugs in clinical practice.Topical patches are recommended by multiple guidelines as the preferred drugs for patients with osteoarthritis due to their comparable efficacy and superior safety than oral preparations.Acetaminophen is only recommended for short-term treatment or adjuvant therapy while opioids should be used with caution in clinical use due to safety consideration as well as addiction risk.