JBJS 2008;90B:280

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
    1. OA患者のすべてに痛みがない
    2. placebo surgeryで痛みがひく
    3. 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.