最近审阅: 24 十月 2020
最近更新: 13 七月 2018

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 疼痛持续时间大于3个月
  • 躯体性合并症
  • 心理合并症
  • 既往有过急性疼痛发作史
  • 疼痛导致日常生活困难
  • 肌筋膜性疼痛的诱发因素
  • 肌肉骨骼痛的诱发因素
  • 带状疱疹感染
  • 外伤或肢体制动史
  • 使用镇痛药
  • 肌肉痉挛
  • 相关躯体症状
  • 肌肉触痛
  • 激痛点压痛
  • 紧绷肌带
  • 抽搐反应
  • 关节肿胀和压痛
  • 压痛点

其他诊断因素

  • 慢性头痛的诱发因素
  • 持续时间小于或大于2小时的头痛
  • 放射性疼痛
  • 关节晨僵
  • 长时间行走时疼痛,弯腰或坐下可缓解
  • 关节痛
  • 烧灼样疼痛
  • 触诱发痛
  • 痛觉过敏
  • 伴恶心呕吐、畏光畏声的慢性头痛
  • 间歇性慢性头痛
  • 双侧慢性头痛
  • 单侧慢性头痛
  • 全范围关节运动(ROM) 受限
  • 直腿抬高疼痛或受限
  • 肩胛带和骨盆带疼痛分布
  • 对称性身体疼痛分布
  • 尽管治疗,头痛症状仍恶化
  • 头痛伴头或颈的后部疼痛
  • 疼痛肢体的过度肌卫
  • 反射减弱或消失
  • 沿颞动脉分布的压痛

危险因素

  • 年龄大于45岁
  • 女性
  • 妊娠
  • 外伤或慢性疼痛病史
  • 慢性疼痛综合征的家族史
  • 伴有神经系统体征的急性背痛
  • 高危职业
  • 同时存在的人格障碍/心理困扰
  • 疼痛相关残障
  • 吸烟

诊断性检查

需考虑的检查

  • 脊柱、骨骼和关节 X 线平片检查
  • 脊椎 MRI 检查
  • 肌电图和神经传导测定
更多 需考虑的检查

治疗流程

撰稿人

Consultant, Pain Medicine and Anaesthesia

North Bristol NHS Trust

Bristol

UK

利益声明

GC has been sponsored by Boston Scientific, St Jude Medical, and Nevro to attend cadaveric workshops relevant to neuromodulation.

Dr Gaurav Chhabra would like to gratefully acknowledge Dr Sarah Love-Jones and Dr Dawn A. Marcus, previous contributors to this monograph. SLJ has received consultancy fees for Boston Scientific and Nevro Corporation (regarding spinal cord stimulation) and is an Elected Council member of the British Pain Society. DAM is an author of a reference cited in this monograph.

同行评议者展开全部内容

Clinical Instructor

Department of Anesthesiology

University of Washington School of Medicine

Seattle

WA

利益声明

JDS declares that he has no competing interests.

Consultant in Pain Management

Pain Unit

King's College Hospital

London

UK

利益声明

JH has chaired advisory boards for Napp Pharmaceuticals Ltd., chaired a symposium, is a principle investigator and has participated in advisory boards for Grunenthal Ltd., and has given lectures for Pfizer Ltd. JH has also attended the American Pain Society meeting in 2009 sponsored by Grunenthal.

Consultant in Pain Medicine

Pain Management Service

University Hospitals of Leicester

Leicester

UK

利益声明

Not disclosed.

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