Exercise for chronic musculoskeletal pain: A biopsychosocial approach
Exercise for chronic musculoskeletal pain: A biopsychosocial approach
复制标题
DOI：
10.1002/msc.1191
复制
发表时间：
2017-12-01
影响因子：
1.3
通讯作者：
Hubscher, Markus
中科院分区：
文献类型：
--
作者：
Booth, John;Moseley, G. Lorimer;Hubscher, Markus
慢性肌肉骨骼疼痛（CMP）是指骨骼、关节和身体组织持续疼痛超过3个月。对于这些情况，人们普遍认为继发性病理或持续疼痛的后果，包括运动恐惧，疼痛灾难化，焦虑和神经系统敏感化似乎是疼痛和残疾的主要原因。虽然运动是CMP的主要治疗方式，但其目的往往是改善身体功能，而对继发病变的关注较少。运动干预CMP的继发性病理与当代疼痛康复实践相一致，比单独运动更有可能改善患者的预后。生物心理社会治疗承认并解决疼痛和残疾的生物，心理和社会贡献，目前被视为治疗慢性疼痛最有效的方法。本临床更新讨论了关于CMP运动处方的生物心理社会方法的关键方面，并考虑了患者需求和临床医生能力。目前的共识是，根据患者的表现、目标和偏好，进行个性化的、有监督的运动，这些运动被认为是安全和无威胁的，以避免在体育活动和疼痛之间形成无益的联系。有氧运动和阻力运动研究提供了支持运动治疗CMP的有力证据，尽管在如何最好地将这些发现应用于运动处方方面存在相当大的不确定性。在这一临床更新中，我们还通过综合运动和CMP康复领域已发表的工作，为CMP的运动处方提供循证指导。
Chronic musculoskeletal pain (CMP) refers to ongoing pain felt in the bones, joints and tissues of the body that persists longer than 3months. For these conditions, it is widely accepted that secondary pathologies or the consequences of persistent pain, including fear of movement, pain catastrophizing, anxiety and nervous system sensitization appear to be the main contributors to pain and disability. While exercise is a primary treatment modality for CMP, the intent is often to improve physical function with less attention to secondary pathologies. Exercise interventions for CMP which address secondary pathologies align with contemporary pain rehabilitation practices and have greater potential to improve patient outcomes above exercise alone. Biopsychosocial treatment which acknowledges and addresses the biological, psychological and social contributions to pain and disability is currently seen as the most efficacious approach to chronic pain. This clinical update discusses key aspects of a biopsychosocial approach concerning exercise prescription for CMP and considers both patient needs and clinician competencies. There is consensus for individualized, supervised exercise based on patient presentation, goals and preference that is perceived as safe and non-threatening to avoid fostering unhelpful associations between physical activity and pain. The weight of evidence supporting exercise for CMP has been provided by aerobic and resistance exercise studies, although there is considerable uncertainty on how to best apply the findings to exercise prescription. In this clinical update, we also provide evidence-based guidance on exercise prescription for CMP through a synthesis of published work within the field of exercise and CMP rehabilitation.