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中华老年病研究电子杂志 ›› 2019, Vol. 06 ›› Issue (02) : 28 -34. doi: 10.3877/cma.j.issn.2095-8757.2019.02.002

所属专题: 文献 指南共识

指南与共识

老年患者慢性肌肉骨骼疼痛管理中国专家共识(2019)
纪泉1, 易端2, 王建业3, 蹇在金4, 郑松柏5, 张存泰6, 于普林3,(), 樊碧发7,(), 中华医学会老年医学分会, 中国医师协会疼痛科医师分会   
  1. 1. 100730 北京医院骨科 国家老年医学中心
    2. 100191 北京大学第三医院疼痛医学中心
    3. 100730 北京医院 国家老年医学中心
    4. 410011 长沙,中南大学湘雅二医院老年医学科
    5. 200040 上海,复旦大学附属华东医院老年医学科
    6. 430030 武汉,华中科技大学同济医学院附属同济医院老年病科
    7. 100029 北京,中日友好医院疼痛科
  • 收稿日期:2019-05-10 出版日期:2019-05-28
  • 通信作者: 于普林, 樊碧发

Expert consensus on management of chronic musculoskeletal pain in older adults

Quan Ji1, Duan Yi2, Jianye Wang3   

  • Received:2019-05-10 Published:2019-05-28
引用本文:

纪泉, 易端, 王建业, 蹇在金, 郑松柏, 张存泰, 于普林, 樊碧发, 中华医学会老年医学分会, 中国医师协会疼痛科医师分会. 老年患者慢性肌肉骨骼疼痛管理中国专家共识(2019)[J]. 中华老年病研究电子杂志, 2019, 06(02): 28-34.

Quan Ji, Duan Yi, Jianye Wang. Expert consensus on management of chronic musculoskeletal pain in older adults[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2019, 06(02): 28-34.

表1 老年患者慢性肌肉骨骼疼痛的常用药物
药物 推荐 安全性 代表药物和用法用量
外用NSAIDs 轻、中度疼痛尤其是疼痛部位局限时的首选药物 一般安全性和耐受性好,注意皮肤过敏和诱发哮喘等 氟比洛芬凝胶贴膏:贴于患处,2次/d
对乙酰氨基酚 轻、中度疼痛 高剂量时有肝毒性,定期监测肝功能 不宜超过2 g/d,营养不良患者长期应用应减量
口服NSAIDs 其他方法无效时选用最低、有效剂量并短期使用 NSAIDs与胃肠道、肾和心血管不良反应相关;阿司匹林与之合用时建议加用质子泵抑制剂 洛索洛芬钠:60~120 mg,3次/d,高龄者从最低剂量开始给药;塞来昔布:骨关节炎200 mg,1次/d,或100 mg,3次/d;类风湿关节炎100~200 mg,3次/d
阿片类药 其他方法无效时的中、重度疼痛或功能、生活质量严重下降 不良反应限制其临床应用(便秘、嗜睡、恶心) 嗜羟考酮缓释片:初始剂量5 mg,3次/d,逐渐调整至理想剂量,老年人用法与成年人无差异
曲马多 对乙酰氨基酚和NSAIDs均无效时使用 与抗抑郁药合用可增加癫痫或5-羟色胺综合征风险 小剂量开始,逐渐加量。一般起始剂量为50~100 mg,3次/d,不超过400 mg/d
抗抑郁药 慢性肌肉骨骼疼痛合并焦虑、抑郁状态 便秘、口干等不良反应呈剂量依赖性,推荐低剂量起始 度洛西汀:起始30 m/d连续应用1周,随后增加至60 mg,1次/d
抗惊厥药 治疗神经病理性疼痛、纤维肌痛 不良反应限制了临床应用(如镇静、外周水肿),肾功能不良患者要调整剂量 普瑞巴林:75 mg或50 mg,3次/d,可在1周内根据疗效增加至300 mg/d,最高可至600 mg/d。老年人肾功能减退,应计算肌酐清除率,酌情减量
肌肉松弛剂 缓解慢性腰背痛 存在肝肾功能损害可能,注意四肢无力、困倦、恶心呕吐等不良反应 乙哌立松:50 mg,3次/d,老年患者视症状、年龄酌情减量
抗骨质疏松药 骨质疏松性骨痛 过量补钙会增加肾结石和心血管钙化风险;食管狭窄或迟缓不能患者禁用双膦酸盐,反流性食管炎患者慎用;鲑降钙素鼻喷剂连续使用不超过3个月 钙剂和维生素D作为基本补充剂,老年人推荐钙剂1 000~1 200 mg/d,维生素D 800~1 200 U/d;阿仑膦酸钠:70 mg,1次/周,服用后30 min内避免平卧
表2 老年患者慢性肌肉骨骼疼痛治疗较常用的微创介入和开放手术及其适应证
图1 老年患者慢性肌肉骨胳疼痛管理流程图
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