青少年纤维肌痛的管理:一级基于证据的系统审查
Filippo Migliorini1,2,3, Nicola Maffulli4,5,6, Michael Kurt Memminger2
1Department of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, 06097 Halle (Saale), Germany.
Medical sciences (Basel, Switzerland)
|September 26, 2025
概括
青少年纤维肌痛 (JFM) 治疗具有挑战性. 结合心理治疗与运动的多式疗法显示出对疼痛和功能有希望,副作用比药物更少.
科学领域:
- 儿科风湿病学 儿科风湿病学
- 疼痛管理 疼痛管理
- 基于证据的医学基于证据的医学.
背景情况:
- 青少年纤维肌痛 (JFM) 是青少年的一种慢性疼痛状况,以广泛的疼痛,疲劳和功能限制为特征.
- 由于其复杂性和干预措施的高质量证据有限,有效的JFM治疗是困难的.
研究的目的:
- 对青少年的JFM治疗进行随机对照试验 (RCT) 的I级证据进行批判性审查.
- 评估JFM的药理和非药理干预措施的有效性和安全性.
主要方法:
- 进行了对7项同行评审临床试验的系统审查.
- 研究评估了duloxetine,milnacipran,pregabalin,认知行为疗法 (CBT) 和纤维肌痛综合训练 (FIT) 青少年计划 (CBT + 神经肌肉训练).
- 关键结局包括疼痛强度,功能障碍,抑郁,体力活动和不良事件.
主要成果:
- 药物治疗 (杜洛西丁,米尔纳西普兰,普雷加巴林) 提供了轻微的疼痛缓解,但功能/情绪益处不一致,并经常出现不良反应.
- 认知行为疗法 (CBT) 改善了功能和抑郁症,但对疼痛或目标活动的影响有限.
- 与单独CBT相比,FIT青少年计划在疼痛和功能方面表现出优异的结果,表明了协同作用.
结论:
- 建议JFM使用多模式治疗策略.
- 非药物干预措施,特别是与结构化炼相结合时,提供了具有良好的安全概况的显著益处.
- 需要进一步的大规模,严格的试验来确定最佳的JFM治疗和长期结果.
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