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a.index_btn{}.other_runlin_search{}.runlin_box{}.HJZF_Z__innerContent{}.HJZF_Z__inner_product_categroy5_title{}.HJZF_Z__Breadcrumbs{}body > div:nth-child(5) > div.container > div.HJZF_Z__Breadcrumbs > div > div{}.runlin_banner_right{}.main_newslist3 .newslist_img{}.inner_pro_info{}.inner_pro_info:after{}.runlin_left_inner > div > ul:hover{}.runlin_left_inner{}.runlin_left{}.runlin_left_inner > div > ul:hover span h3{}.index_wrapper{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > a{}#HJZF_Z__innerBanner{}body > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}#HJZF_Z__wrapper > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}.zq_contactus>#HJZF_Z__wrapper>#HJZF_Z__innerBanner{}#payment > div > section.hidden-xs.hidden-sm.hidden-md.col-lg-3.HJZF_Z__inner--left > div > div.HJZF_Z__inner--left__content > div.InsidePages_left_content-main > ul{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > h2:nth-child(1){}.aboutus_37_t b{}.index_title{}.aboutus_37_t b{}.hjzf_news_44_wrapper > li:first-child{}.news_44_list_con > div.news_44_list_con_box > div.index_text{}.other_184{}.aboutus_37_right li{}.aboutus_37_t b{}.aboutus_37_right li:before{}.aboutus_37_con> p{}.index_sub_title{}#bottom-35_1891 > section > div > div > div > div.hjzf_bottom_35_wrapper > div.foot_contact.text-center > h2{}.products_52_wrapper_img{}.products_52_wrapper li{}.products_52_wrapper li a{}#products-52_1891 > section > div > div > div > ul > li > a > h2{}.products_52_wrapper li p{}.mobiles_sidebar{}.foot_contact:before{}.index_sub_title a{}.other_184_right{}.HJZF_contact_inquiry{}.hj_navbar_nav > li > a > h2:before{}.nav_li.on>a h2{}.container-fluid{}.other_184_right{}.other_184_right>.index_sub_title{}#news-44_1891 > section > div > div > div > ul > li > div > div.index_text{}.other_184_right>.con{}.other_184_pagination{}.banner_27_zyzfw{}#aboutus-23_1891 > section > div > div > div > ul > li:nth-child(4){}.main_page{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(2) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(3) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(4) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(5) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(7) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(8) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(9) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(6) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(1) > a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(3).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(3):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(2).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(2):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(4).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(4):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(5).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(5):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(6).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(6):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(7).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(7):hover a{}.HJZF_Z__inner_product_categroy5 ul 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img{}.runlin_banner{}.runlin_banner_left{}.runlin_banner_right{}.runliin_top_email{}.runlin_email.first{}.runlin_des + .more{}.runlin_left li{}.runlin_yiji > span h3{}.submit_runlin_search{}.nav_drop{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > div.runlin_des > b{}.hjzf2_z_products_list_left a.index_btn{}.other_runlin_search{}.runlin_box{}.HJZF_Z__innerContent{}.HJZF_Z__inner_product_categroy5_title{}.HJZF_Z__Breadcrumbs{}body > div:nth-child(5) > div.container > div.HJZF_Z__Breadcrumbs > div > div{}.runlin_banner_right{}.main_newslist3 .newslist_img{}.inner_pro_info{}.inner_pro_info:after{}.runlin_left_inner > div > ul:hover{}.runlin_left_inner{}.runlin_left{}.runlin_left_inner > div > ul:hover span h3{}.index_wrapper{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > a{}#HJZF_Z__innerBanner{}body > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}#HJZF_Z__wrapper > div.HJZF_Z__innerBanner.HJZF_Z__innerBanner2{}.zq_contactus>#HJZF_Z__wrapper>#HJZF_Z__innerBanner{}#payment > div > section.hidden-xs.hidden-sm.hidden-md.col-lg-3.HJZF_Z__inner--left > div > div.HJZF_Z__inner--left__content > div.InsidePages_left_content-main > ul{}body > div:nth-child(5) > div.runlin_banner > div.runlin_box > div > div > div > div > div.runlin_banner_right > h2:nth-child(1){}.aboutus_37_t b{}.index_title{}.aboutus_37_t b{}.hjzf_news_44_wrapper > li:first-child{flex:0 0 100%}.news_44_list_con > div.news_44_list_con_box > div.index_text{}.other_184{}.aboutus_37_right li{}.aboutus_37_t b{}.aboutus_37_right li:before{}.aboutus_37_con> p{}.index_sub_title{}#bottom-35_1891 > section > div > div > div > div.hjzf_bottom_35_wrapper > div.foot_contact.text-center > h2{}.products_52_wrapper_img{}.products_52_wrapper li{}.products_52_wrapper li a{}#products-52_1891 > section > div > div > div > ul > li > a > 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section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(4) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(5) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(7) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(8) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(9) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(6) > a{}body > div:nth-child(10) > div > div > section.hidden-xs.hidden-sm.hidden-md.col-xs-12 > div > ul > li:nth-child(1) > a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(3).on a, .HJZF_Z__inner_product_categroy5 ul li:nth-child(3):hover a{}.HJZF_Z__inner_product_categroy5 ul li:nth-child(2).on a, 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秋冬关节疼痛,止痛药选择外用还是口服?
  2024/10/25| 阅读次数:530

秋冬季节,乍暖还寒,最难将息,关节疼痛常常不期而遇。



关节,为何会疼痛?


关节疼痛只是一个症状,不是一个病名。骨关节炎、滑膜炎、运动损伤、感染、痛风、自身免疫性疾病(比如风湿和类风湿)、血液病、肿瘤等等多种疾病都会出现关节痛的症状。其中,骨关节炎最为常见,有研究发现60岁以上的人70%都有骨关节炎。


骨关节炎也被称为“退变型关节炎”“老年性关节炎”“肥大性关节炎”,大众常把它叫做“老寒腿”或“风湿关节痛”,表现为缓慢发展的关节疼痛、压痛、僵硬、关节肿胀、活动受限和关节畸形等,最常出现退变性骨关节炎的地方是膝关节和髋关节,其他如踝关节、手指关节、脊柱的关节也常发生骨关节炎。


关节一旦疼痛,不仅仅是引起身体不适那么简单,还会影响情绪、睡眠等方方面面,疼痛严重者导致活动受限、生活无法自理。



关节疼痛,如何治疗?


对轻度或中度的骨关节炎,药物疗效明确,而且简便易行、容易坚持。


但很多人觉得“是药三分毒”,认为“止疼药伤胃”“止疼药上瘾”,就算腿疼得受不了,还是硬撑着不敢、不愿吃止痛药。


根据临床治疗指南,我们常用的止痛药——非甾体抗炎药(NSAIDs)是治疗骨关节炎疼痛的首选药物。它的全称是消炎镇痛药,它们不是阻断人们对疼痛的感觉,而是通过消炎作用让炎症缓解,自然就不痛了。


非甾体抗炎药是通过抑制环氧化酶,使参与机体多种生理、病理过程的介质前列腺素( PGs) 的生成减少,从而起到抗炎、解热、镇痛的作用。根据药物对环氧化酶的选择性抑制作用,将其分为传统非选择性NSAIDs和特定NSAIDs——COX-2抑制剂。


微信图片_20241025143241.png



口服VS外用,止痛药怎么选?


非甾体抗炎药剂型众多,有片剂、胶囊剂、颗粒剂、贴剂、栓剂、注射剂等等。面对这么多的止痛药物,许多人常常会疑惑:是选择口服药物还是外用药物呢?


口服NSAIDs虽然效果显著,但它是通过胃肠道、血液吸收,会刺激胃肠道,还会对心脏产生不良影响[1]。心血管风险较高的患者及身体虚弱的患者指南不建议将口服NSAIDs作为首选药物。


而外用NSAIDs,可以直接经过皮肤作用于疼痛部位,减少全身副作用的风险,尤其适合轻至中度的关节疼痛及合并胃肠疾病、心血管疾病或身体虚弱的患者[2]。在使用口服药物前,建议先选择局部外用药物如:吡罗昔康贴剂,局部外用药可迅速、有效缓解关节的轻、中度疼痛,全身不良反应轻。


亮克®吡罗昔康贴片,是国内首个获批治疗关节炎的吡罗昔康贴片剂型。


强效镇痛成分+经皮控释的剂型,高效持久止痛,长达24小时;

局部用药、靶向治疗,准确掌握剂量,更为安全;

减轻软骨的破坏,起到保护软骨的作用;

透气性好,不刺激皮肤不易过敏,无异味;


当然,若疼痛症状持续存在或中重度疼痛的患者可以口服非甾体药物、辅助增加其他治疗[3],但要警惕胃肠道和心血管的不良事件。


骨关节炎的治疗是一个综合化、个性化及阶梯化治疗的过程,改善疼痛药物只是冰山一角,选用何种治疗方式,是否需要药物干预或已经到了需要更积极治疗的阶段,这些都需要医生的专业评估来决定。


参考文献
[1] 李志刚,王小荣.非甾体抗炎药不良反应综述[J].浙江药师,20051(10): 40-41.
[2] 中国骨关节炎疼痛管理临床实践指南(2020年版)[J].中华骨科杂志,2020,40(8):469-476.
[3]中国骨关节炎诊疗指南专家组中国老年保健协会疼痛病学分会中国骨关节炎诊疗指南(2024版)[J]. 中华疼痛学杂志. 2024,20(3):323-338

【声明】文章内容不作为临床诊疗依据,仅供交流、学习。


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