Arthritis pain "death to live", these methods are too useful! Guide time.

Pain is the primary complaint of patients with OA, so it is necessary to standardize the pain management of OA.according to editors, osteoarthritis (OA) is a common joint disease.pain is the primary complaint of patients with OA, so it is necessary to standardize the pain management of OA.the Chinese guidelines for clinical practice of pain management of osteoarthritis (2020 Edition) has formed 14 recommendations, involving non drug treatment (exercise therapy, health education, weight management, etc.) and drug treatment of OA pain management, in order to provide clinical guidance and help for the practice of pain management in OA in China.OA is a degenerative disease with joint pain as the main symptom, which is caused by many factors, such as articular cartilage fibrosis, chaps, ulcers and loss. It often affects the knee joint, hip joint, spine and hand. It is common in the middle-aged and elderly people, and more than half of the people aged 65 and above suffer from OA.the results of the China Health and pension follow-up survey (Charls) show that the prevalence of symptomatic knee OA is as high as 8.1% in people aged 45 and above in China.pain seriously affects the quality of life of patients, and even indirectly increases the incidence of cardiovascular events and all-cause mortality.as the main symptom of OA, pain has become one of the main sources of disease burden of musculoskeletal system, especially in China.therefore, scientific and effective management of OA pain is very important to relieve pain symptoms, reduce disease burden and improve quality of life.01 the first step in the treatment of OA is to lose weight and lose weight! Overweight and obesity are recognized risk factors of knee OA.for example, for every 5 kg / m2 increase in body mass index (BMI), the risk of knee OA increases by 35%.many OA clinical practice guidelines strongly recommend weight management for obese OA patients, so as to relieve pain and improve function.the OA pain management guidelines and OA pain management guidelines issued by the European Union Against Rheumatism (EULAR) and the OA non-surgical treatment guidelines issued by the international Osteoarthritis Research Association (OARSI) strongly recommend exercise therapy for the management of OA pain.strength training and aerobic exercise are beneficial to relieve knee OA pain. It is suggested that the frequency of exercise should be three times a week for 8-11 weeks or 12-15 weeks.meta analysis results showed that pulse ultrasound therapy can effectively relieve pain symptoms and significantly improve knee joint function in patients with knee OA, and there is no obvious side effect of any kind of ultrasound therapy.the OARSI guidelines for non-surgical treatment of OA in 2019 have begun to conditionally recommend ultrasound therapy for OA.in 2014, the National Institute for health and clinical optimization (NICE) guidelines recommended percutaneous electrical stimulation as a complementary therapy for the relief of OA pain. another mesh meta-analysis published in the official journal of OARSI in 2015 further found that among various kinds of percutaneous electrical stimulation therapy, interference current electrical stimulation therapy has the best effect on relieving knee OA pain symptoms. 02 drug treatment of NSAIDs is the first choice, and external use is safer! However, the side effects of AIDS are similar to those of AIDS in the treatment of skin pain. compared with oral NSAIDs, topical NSAIDs can reduce the risk of cardiovascular events by 36%, especially in long-term use. the guidelines for non-surgical treatment of osteoarthritis published by OARSI in 2019 strongly recommend topical NSAIDs for patients with knee OA, especially for patients with gastrointestinal and / or cardiovascular diseases, as well as elderly and frail patients. guidelines issued by the American Society of Rheumatology (ACR) in 2019 strongly recommend NSAIDs for patients with knee OA and conditionally recommend NSAIDs for patients with hand OA. in the selection of external drug dosage forms, only 10% - 20% of the topical ointment can enter the body through the skin, while the transdermal patch can improve the bioavailability by adding penetration enhancers, and has better patient compliance. guidelines for the diagnosis and treatment of osteoarthritis (2018 Edition) suggested that NSAIDs for external use should be prior to oral NSAIDs. When the curative effect is poor, external use of NSAIDs can be combined with oral NSAIDs for moderate and severe pain. some studies have compared the conventional dose of diclofenac, naproxen, ibuprofen, rofecoxib, celecoxib and etocoxib in the treatment of knee and hip OA, and found that oral diclofenac 150 mg / D and etocoxib 60 mg / d have the best effect on pain relief and function improvement; diclofenac 150 mg / D is better than celecoxib 200 mg / D, naproxen 1 000 mg / D, ibuprofen 2400 Mg / D was more effective than etoposide 60 mg / d. another study found that oral NSAIDs had comparable analgesic effects with opioids. as oral NSAIDs have a high incidence of gastrointestinal and cardiovascular adverse events, selective COX-2 inhibitors or nonselective NSAIDs combined with proton pump inhibitors are recommended for patients with high risk of gastrointestinal reactions. however, oral NSAIDs are not recommended as the first choice for patients with high cardiovascular risk and weak health. there was no significant difference between opioids and NSAIDs in relieving pain, but there was a certain degree of addiction and adverse reactions. the guidelines for non-surgical treatment of osteoarthritis published by OARSI in 2019 strongly oppose the use of oral or topical opioids in pain management of OA. a recent study found that early tramadol analgesia increased the risk of all-cause mortality, myocardial infarction, and hip fracture in OA population aged 50 and above. therefore, opioid drugs including tramadol are not recommended as the first-line drugs for pain management in OA. compared with celecoxib, naproxen, ibuprofen and other NSAIDs commonly used in the treatment of OA, duloxetine had no significant difference in improving WOMAC score of OA patients. in terms of relieving OA pain and improving function of knee joint, duloxetine group is better than placebo group, but the incidence of adverse events in duloxetine group is higher. therefore, the safety of duloxetine should be considered when using duloxetine, and it is mainly used for patients with long-term, chronic, intractable pain or depression. 03 glucosamine for intra-articular injection is useless! Intra articular injection of glucocorticoid can relieve pain and improve function in a short time, but it has no significant effect on pain and function improvement in medium and long term. OARSI guidelines for non-surgical treatment of OA in 2019 are weak, and intra-articular injection of glucocorticoid is recommended for the treatment of knee OA. it is suggested that the same joint should not be injected repeatedly, and the injection interval should not be shorter than 4-6 months. for intra-articular injection of hyaluronic acid, there are differences in the direction and intensity recommended by different OA guidelines. if the AAOS guidelines do not recommend intra-articular injection of hyaluronic acid, the 2014 OARSI guidelines consider that the direction and intensity of recommendations are uncertain, but the updated OARSI guidelines in 2019 have been changed to weak recommendations, while the ACR guidelines are weakly opposed. compared with saline injection, hyaluronic acid did not increase the risk of adverse events and had higher safety. in terms of economic evaluation, intra-articular injection of hyaluronic acid can delay the operation time of joint replacement and reduce medical costs. diacerein is an interleukin-1 inhibitor. By inhibiting its production, activity and subsequent effects, diacerein inhibits cartilage degradation, promotes cartilage synthesis and inhibits synovial inflammation. Diacerein can effectively relieve OA pain, improve joint function, and possibly delay the progression of OA. esceo recommended diacerein as the first-line drug in the treatment of OA. some studies have found that diacerein can improve the symptoms of OA from 2 weeks, and the analgesic effect is similar to that of NSAIDs. diacerein has cardiovascular protection and no risk of cardiovascular events, and can inhibit the pro atherosclerotic effect of interleukin-1. glucosamine is no more effective than placebo in the treatment of knee and hip OA. However, glucosamine did not increase the incidence of adverse events compared with placebo. no effective evidence of chondroitin sulfate in the treatment of OA pain has been published. in OA pain management, the effectiveness of acupuncture is still controversial. some studies have confirmed that acupuncture can only relieve knee OA pain in a short time, but has no obvious effect on hip OA pain. of course, we should also pay attention to the safety of acupuncture treatment. the existing research evidence on Chinese medicine in OA pain management is limited. OA patients undergoing pain management need long-term medication due to persistent pain, and the safety of long-term medication needs to be paid attention to. NICE guidelines recommend that patients with symptomatic OA need to be regularly followed up and monitored for their symptoms, function and quality of life, especially those with persistent joint pain, multi joint pain and cardiovascular or gastrointestinal complications. Chinese guidelines for diagnosis and treatment of osteoarthritis (2018 Edition) also pointed out that OA patients should pay attention to the potential risk of medical diseases, and corresponding tests and examinations should be conducted according to the condition of patients after 3 months of medication. ● summary ● OA pain management aims to restore joint function, improve quality of life and restore mental state. it can be managed by non drug methods or drug treatment methods; secondly, drug use is a common OA pain management measure, but the long-term efficacy of drugs to alleviate OA pain is still uncertain; if non drug methods and drug treatment still can not alleviate OA pain, surgical treatment is a choice that can be considered, which is not included in this guideline. References: Chinese Journal of orthopedics, 2020,40 (08): 469-476