How painful is juvenile chronic arthritis?
How painful is juvenile chronic arthritis?
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DOI：
10.1136/adc.77.5.451
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发表时间：
1997-11-01
影响因子：
5.2
通讯作者：
Helders, PJM
中科院分区：
文献类型：
--
作者：
Kuis, W;Heijnen, CJ;Helders, PJM
疼痛是一种与实际或潜在的组织损伤相关的不愉快的感觉和情绪体验，是关节炎的主要症状之一。 2-4 疼痛也是提醒患者产生保护性反应的感觉方式。疼痛还告诉患者存在潜在的有害威胁，这使他或她去看医生以诊断和治疗他的疾病（或小病）。不幸的是，像急性疼痛这样的警告信号可能会变成慢性疼痛，在这个阶段，疼痛本身可能是最主要的症状，并对患者的生活质量构成威胁。在炎性疼痛的发病机制中，对炎症产生的有害刺激敏感的受体发挥了作用。这些受体称为伤害感受器，主要激活无髓鞘的小直径感觉神经，将伤害感受信息传递给脊髓背角的高级神经元。在脊髓和脊髓上水平，伤害性信号通过调节通路进行调节（图 1）。除了这些调节途径之外，还有许多物质能够直接刺激和/或使初级疼痛感受纤维敏感（表 1）。 5 6 儿童表达疼痛的方式与成人不同。 7 这通常被解释为儿童感觉疼痛较少甚至没有，就像新生儿一样。新生儿和儿童对疼痛的感知与成人根本不同，这一观点导致了不人道的治疗方法。 1985 年对英国儿科麻醉师的一项调查显示，48% 的受访者从未在大手术期间或之后为新生儿提供任何类型的术后镇痛。 8 9疼痛感知的差异解释了为什么文献中关于幼年慢性关节炎儿童的疼痛存在如此多的差异。一些研究报告称，与患有类风湿性关节炎的成人相比，患有幼年慢性关节炎的儿童所经历的疼痛要少得多，甚至没有疼痛。 10 然而，我们和其他人发现患有幼年慢性关节炎的儿童确实会表现出疼痛。 11-16 通过使用测速法，我们发现与健康年龄相关的对照组相比，患有幼年慢性关节炎的儿童对有害刺激的敏感性增强。 15 当青少年慢性关节炎患者关节发炎活跃时，疼痛阈值降低 31%。之间存在显着的负相关关系
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage1 and it is one of the major symptoms in arthritis. 2–4 Pain is also the sensory modality that alerts patients so that it leads to protective responses. Pain also informs the patient that there is a potential noxious threat, which brings him or her to the doctor for diagnosis and treatment of his illness (or ailment). Unfortunately, a warning signal like acute pain can turn into chronic pain and in this stage pain itself can be the most dominant symptom and threat for the quality of life of the patient. In the pathogenesis of inflammatory pain, receptors sensitive for noxious stimuli generated as a consequence of inflammation, have a role. These receptors, called nociceptors, activate predominantly unmyelinated, small diameter sensory nerves, mediating nociceptive information to higher order neurones in the dorsal horn of the spinal medulla. On spinal as well as supraspinal level, the nociceptive signal is modulated by regulating pathways (fig 1). Besides these regulating pathways there are many substances that are able to stimulate directly and/or sensitise primary aVerent nociceptive fibres (table 1). 5 6 Children express pain in a diVerent way than adults do. 7 This is often interpreted as if children feel less or even no pain as in the case of neonates. The idea that newborns and children diVer fundamentally from adults in the perception of pain, has led to approaches that are not humane. In a survey of British paediatric anaesthetists in 1985 it appeared that 48% of the respondents never provided postoperative analgesia of any kind to neonates during or after major surgery. 8 9DiVerences in pain perception explain why there are so many discrepancies in the literature with respect to pain in children with juvenile chronic arthritis. Some investigations report that children with juvenile chronic arthritis experience substantially less pain or even no pain in comparison to adults with rheumatoid arthritis. 10 However, we and others have found that children with juvenile chronic arthritis do express pain. 11–16 By using algometry, we found an enhanced sensitivity in children with juvenile chronic arthritis to noxious stimulation in comparison to healthy age related controls. 15 When juvenile chronic arthritis patients had actively inflamed joints, the pain threshold was reduced by 31%. There was a significant inverse correlation between