Grilym SE, Pollard TCB, Carr AJ Understanding pain in osteoarthritis. J Bone Joint Surg 2008;90B:280-287
- OAによる痛みのジレンマ
- OA患者のすべてに痛みがない
- placebo surgeryで痛みがひく
- 人工関節置換をしても10%痛みが残る
- 人工関節置換術後も10%以上痛みを訴える
- two factor
- 1)genetic and psychosocial factors
- 女性に多い、患者の期待、術前社会的支援が大きいと術後成績がよい
- 2)中枢神経系
- 中枢性の感作、phantom joint concept
- 患者立脚評価法で人工関節手術後15-30%は不満足 理由は持続する痛み
- 痛みの原因が関節外にあるので、joint replacementしても改善しない
- We are managing pain behavior and distress, rather than a pure nociceptor stimulus
- Central to the management of this group of patients is an assessment of their pain, its facets and sites which may be amenable to intervention
- psychosocial factors (catastrophising, low self-efficacy, poor social support), biological factors (cartilage damage, inflammaion, altered biomechanics)の両方がpain, disabilityに関与している。双方の因子に対応した治療
- The influence of a patient's psychological state, social situation and past experiences will all influence the pain displayed, and identifying the importance of these factors requires a detailed assessment of th patient and their pain.
- An appreciation of the multi-dimensional nature of the perception of pain will enable the surgeon to apply a more robust pre-operative assessment of a patient's suitability for surgery.
