Perineural local anesthetic treatments for osteoarthritic pain.
Perineural local anesthetic treatments for osteoarthritic pain.
复制标题
骨性关节炎疼痛的神经周围局部麻醉治疗。
DOI：
10.1007/s40883-021-00223-0
复制
发表时间：
2021-09
影响因子：
2.6
通讯作者：
Nair, Lakshmi S
中科院分区：
文献类型：
--
作者：
Knight, Brittany;Walker, Joseph;Nair, Lakshmi S
骨关节炎（OA）最常见的致残症状是疼痛。使用疾病特异性动物模型的临床研究增加了我们对骨关节炎疼痛病理生理学的了解。随着骨关节炎患病率的持续上升，目前可用的治疗方案不能提供最佳的疼痛缓解水平，开发治疗骨关节炎疼痛的机会正在增加。局部麻醉剂沿着感觉/运动神经的靶向给药可以提供一种治疗骨关节炎疼痛的替代策略。此外，与传统的关节内注射相反，工程化治疗药物递送系统的发展可以允许局部麻醉剂的持续神经周围递送。本文综述了1）与髋关节、肩关节和膝关节OA相关的持续性疼痛的病理生理学和2）局麻药在为关节相关疼痛症状提供镇痛方面的新兴治疗作用。骨关节炎疼痛是患者就医的最常见原因之一。然而，常见的口服镇痛治疗充满了几个临床挑战，包括脱靶副作用、成瘾和镇痛疗效持续时间短。将局麻药直接递送到周围神经元周围的神经周隙被证明是一种可能上级于传统镇痛方法的临床方法。本文综述了目前骨关节炎疼痛的诊断和治疗方法，以及局部麻醉注射治疗肩、髋和膝关节疼痛的临床数据。此外，本综述还介绍了超声引导局部给药和生物材料缓释给药系统在临床上的应用，这两种给药系统都可能为骨关节炎疼痛的镇痛治疗提供进一步的进展。
The most common disabling symptom of osteoarthritis (OA) is pain. Clinical investigations using disease-specific animal models have increased our insights into the pathophysiology of osteoarthritic pain. As the prevalence of OA continues to rise and current available treatment options give less than optimal levels of pain relief, opportunities to develop treatments to address osteoarthritic pain are increasing. Targeted administration of local anesthetics along sensory/motor nerves can provide an alternative strategy for managing osteoarthritic pain. Moreover, the development of engineered therapeutic drug delivery systems may allow for sustained perineural delivery of local anesthetics as opposed to the traditional intraarticular joint injections. This review presents an overview of 1) the pathophysiology of persistent pain associated with OA of the hip, shoulder, and knee and 2) the emerging therapeutic role of local anesthetics in providing analgesia for joint-related pain symptoms. Osteoarthritic pain is one of the most common reasons patients seek medical attention. However, common oral analgesic treatments are fraught with several clinical challenges including off-target side-effects, addiction, and short duration of analgesic efficacy. Direct delivery of local anesthetics to the perineural space surrounding peripheral neurons are proving to be forthcoming clinical approach that may be superior to traditional analgesic approaches. This review describes current diagnostic and therapeutic approaches for osteoarthritis pain and the clinical data regarding local anesthetic injections for shoulder, hip, and knee joint pain. Furthermore, this review describes the future directions for clinical use of ultrasound-guidance for focal drug delivery and biomaterial drug delivery systems for sustained drug release which both may provide further advancements for analgesic treatments of osteoarthritis pain.