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Revista de la Sociedad Española del Dolor

versão impressa ISSN 1134-8046


RODRIGUEZ-HERNANDEZ, J. L.. Osteomuscular and rheumatic pain. Rev. Soc. Esp. Dolor [online]. 2004, vol.11, n.2, pp.56-64. ISSN 1134-8046.

Within osteomuscular and rheumatic pain, we found several conditions. Osteoarthrosis or osteoarthritis is an inflammatory joint disease that produces structural disorders in the hyaline cartilage of the joints and sclerosis of the subchondral bone. It has a multifactorial etiology, with symptoms located at the joints affected and its treatment focuses on pain, inflammation, functional status and prevention of deformities. Rheumatoid arthritis is a chronic disease that affects the connective tissue. It causes chronic synovitis with affectation of peripheral joints. Its etiology is unknown and significant immunology disorders have been found. Its onset is insidious and slow, with rigidity in the upper limb joints. Analgesic treatment is, thus, very important, as well as the administration of drugs capable of changing the course of the disease. Ankylosing spondylitis is a chronic systemic inflammatory disease that affects in particular the axial skeleton and rarely the peripheral joints. Most patients are HLA-B27 positive and may present family aggregation. Its onset occurs mainly at the end of the adolescence and most frequently in men. The treatment aims to maintain the spine mobility, in order to avoid ankylosis, pain and inflammation. Gout is a metabolic disease characterized by the deposition of urate monosodium crystals from over-saturated extracellular liquids. Its clinical manifestations range from acute gouty arthritis to intercritical gout and chronic tophaceous gout. The diagnosis is based on the examination of joint fluid. The treatment is based on colchicine, to which NSAIDs and occasionally corticoids or ACTH may be added. Musculotendinous pain syndromes occur at shoulder, elbow, wrist, hip, knee, ankle and foot level. They present local clinical manifestations and the treatment is based in local infiltrations, iontophoresis and sometimes TENS and ultrasounds. Myofascial pain syndrome is a regional pain condition that frequently affects the scapular and pelvic waist. It presents pain triggering points and muscular contracture. Treatment is focused on pain management, recovery of the muscular force and mobility. Fibromyalgia is a chronic generalized non-articular painful condition with predominance of muscular involvement and sensitivity in multiple predefined points. It is more frequently seen in middle-aged women. Its physiopathology is not clear. Low levels of tryptophan and a significant increase of the S/S type of the 5 HT transporting gene have been found. N-methyl-D-aspartate receptors seem also to be involved in this syndrome when they are activated and family aggregation has also been found, probably due to genetic predisposition. Its diagnosis is based on the criteria published by the American College of Rheumatology. This disease requires a pharmacological, physical and rehabilitative treatment, also focused on psychological disorders.

Palavras-chave : Osteomuscular pain; Rheumatic pain; Inflammatory diseases; Locomotor system; Musculotendinous painful syndromes.

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