涡流浴缓解疼痛的疗效与机制研究进展

doi:10.3969/j.issn.1006-9771.2021.01.013

摘要/Abstract

摘要： 涡流浴通过旋涡式流体力学与温热效应，调控疼痛闸门，促进血液循环，增加组织延展性，提高痛阈，可缓解骨关节炎疼痛，改善关节僵硬；减轻肌筋膜炎疼痛和焦虑症状；缓解运动后迟发性肌肉酸痛；降低产妇分娩后的痛觉敏感性；联合其他物理治疗，还能改善肩手综合征的肿胀、疼痛和痉挛症状。涡流浴通过外周温度、机械等刺激局部组织，提高血管渗透率，加快疼痛介质代谢，减少伤害性刺激对外周伤害感受器的影响；促进机体产生镇痛物质，调节自主神经系统，调控疼痛闸门，进而缓解疼痛。涡流浴的具体治疗参数在不同研究中区别较大，有待进一步规范。

关键词: 水疗, 涡流浴, 疼痛, 康复, 综述

Abstract: Whirlpool hydrotherapy regulates the threshold through mechanical and thermal effect, promotes blood circulation, increases tissue malleability, and raises pain threshold, to relieve pain. Whirlpool can relieve osteoarthritis pain and improve joint stiffness, relieve myofascial pain and anxiety symptoms, relieve delayed-onset muscle soreness, reduce the sensitivity of pain after delivery. Combined with other physical therapy, it also significantly improves the swelling, pain and spasm of shoulder-hand syndrome. The main mechanism of whirlpool associates with improving the physiological environment of the local tissue, such as increasing the permeability of the vessel, to accelerate the metabolism of the pain media, reduce the nociceptive stimulation on the peripheral receptors; promoting the produce of analgesic substance; regulating the autonomic nervous system and pain gate. However, the specific treatment parameters are different in the studies, which need to be standardized.

Key words: hydrotherapy, whirlpool, pain, rehabilitation, review

中图分类号:

R454.5

何佩珏, 黄敏, 王谦, 刘韬, 王清. 涡流浴缓解疼痛的疗效与机制研究进展[J]. 《中国康复理论与实践》, 2021, 27(1): 93-96.

HE Pei-jue, HUANG Min, WANG Qian, LIU Tao, WANG Qing. Advance in Whirlpool Hydrotherapy for Pain (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(1): 93-96.

参考文献

1 Becker B E. Aquatic therapy: scientific foundations and clinical rehabilitation applications [J]. PM R, 2009, 1(9): 859-872.
2 孙增春,何成奇. 水疗在运动系统疾病中的应用进展[J]. 华西医学, 2013, 28(10): 1638-1640. Sun Z C, He C Q. Application progress of hydrotherapy in sports system diseases [J]. West Chin Med J, 2013, 28(10): 1638-1640.
3 Al-Qubaeissy K Y, Fatoye F A, Goodwin P C, et al. The Effectiveness of hydrotherapy in the management of rheumatoid arthritis: a systematic review [J]. Musculoskeletal Care, 2013, 11(1): 3-18.
4 Lim K O, Lee D Y, Shin W S. The effects of a warm whirlpool bath on pain and stiffness of patients with chronic stroke induced knee osteoarthritis [J]. Phys. Ther. Sci,2013,25(7):873-875.
5 Im S H, Han E Y. Improvement in anxiety and pain after whole body whirlpool hydrotherapy among patients with myofascial pain syndrome [J]. Ann Rehabil Med, 2013, 37(4): 534-540.
6 Meeker B J. Whirlpool therapy on postoperative pain and surgical wound healing: an exploration [J]. Patient Educ Couns, 1998, 33(1): 39-48.
7 Kuligowski L A, Lephart S M, Giannantonio F P, et al. Effect of whirlpool therapy on the signs and symptoms of delayed-onset muscle soreness [J]. J Athl Train, 1998, 33(3): 222-228.
8 Benfield R D, Hortobagyi T, Tanner C J, et al. The effects of hydrotherapy on anxiety, pain, neuroendocrine responses, and contraction dynamics during labor [J]. Biol Res Nurs, 2010, 12(1): 28-36.
9 Saeki Y, Nagai N, Hishinuma M. Effects of footbathing on autonomic nerve and immune function [J]. Complement Ther Clin Pract, 2007, 13: 158-165.
10 方杰,潘翠环,苏久龙,等. 上肢漩涡浴与运动疗法对脑卒中后肩手综合征的疗效[J]. 中国康复医学杂志, 2013, 28(2): 160-162. Fang J, Pan C H, Su J L, et al. Effect of upper limb whirlpool bath and exercise therapy on shoulder-hand syndrome after stroke [J]. Chin J Rehabil Med, 2013, 28(2): 160-162.
11 Williams A C, Craig K D. Updation the definition of pain [J]. Pain, 2016, 157(11): 2420-2423.
12 Sturgeon J A, Dixon E A, Darnall B D, et al. Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study [J]. Pain, 2015, 156(12): 2627-2633.
13 Xiao H, Liu H, Liu J, et al. Pain prevalence and pain management in a Chinese hospital [J]. Med Sci Monit, 2018, 24: 7809-7819.
14 中国中西医结合学会骨伤科专业委员会. 膝骨关节炎中西医结合诊疗指南[J]. 中华医学杂志, 2018, 98(45): 3653-3658. Professional Committee of Orthopedics and Traumatology of China Association of Integrated Traditional Chinese and Western Medicine. Guide to Diagnosis and Treatment of Knee Osteoarthritis with Integrated Traditional Chinese and Western Medicine [J]. Natl Med J Chin, 2018, 98(45): 3653-3658.
15 严攀,刘波,阴俊,等. 西安大略和麦克马斯特大学骨关节炎指数用于膝退行性骨关节炎患者评定的反应度研究[J]. 中国康复医学杂志, 2016, 31(2): 215-216. Yan P, Liu B, Yin J, et al. Study on the responsiveness of osteoarthritis index of Western Ontario and McMaster University in evaluating patients with knee degenerative osteoarthritis [J]. Chin J Rehabil Med, 2016, 31(2): 215-216.
16 Hubbard M J, Hildebrand B A, Battafarano M M, et al. Common soft tissue musculoskeletal pain disorders [J]. Prim Care, 2018, 45(2): 289-303.
17 Sharma D, Kumar K, Yadav N, et al. To compare the effect of different time ratio of heat and cold in contrast bath on clinical improvement in plantar fasciitis [J]. Int J Orthop Sci, 2017, 3(2): 146-149.
18 王苏梅,祝玉琴,陈玉芬,等. 非药物减痛分娩法对产妇血浆皮质醇及分娩疼痛的影响[J]. 中国妇幼保健, 2010, 25(25): 3570-3572. Wang S M, Zhu Y Q, Chen Y F, et al. Effect of non-drug pain-relieving delivery method on maternal plasma cortisol and labor pain [J]. Matern Child Health Care Chin, 2010, 25(25): 3570-3572.
19 神经病理性疼痛诊疗专家组. 神经病理性疼痛诊疗专家共识[J]. 中国疼痛医学杂志, 2013, 19(12): 705-710. Expert Group on Diagnosis and Treatment of Neuropathic Pain. Expert Consensus on Diagnosis and Treatment of Neuropathic Pain [J]. Chin J Pain Med, 2013, 19(12): 705-710.
20 任海龙,邵东燕,李琦,等. NK细胞应用于肿瘤免疫治疗的研究进展[J]. 现代免疫学, 2017, 37(3): 61-65. Ren H L, Shao D Y, Li Q, et al. Research progress of NK cells in tumor immunotherapy [J]. Curr Immunol, 2017, 37(3): 61-65.
21 Coruzzi P, Ravanetti C, Musiari L, et al. Circulating opioid peptides during water immersion in normal man [J]. Clin Sci, 1988, 74(2): 133-136.
22 张克莹,都健单,风平. 蛋氨酸脑啡肽的免疫调节作用及应用新进展[J]. 中国免疫学杂志, 2017, 33(5): 788-792. Zhang K Y, Du J D, Feng P. New progress in immunomodulation and application of methionine enkephalin [J].Chin J Immun, 2017, 33(5): 788-792.
23 Peiffer J J, Abbiss C R, Nosaka K, et al. Effect of cold water immersion after exercise in the heat on muscle function, body temperatures, and vessel diameter [J]. J Sci Med Sport, 2007, 12(1): 91-96.
24 刘钰,何永恒. 疼痛机制的分子生物学研究进展[J]. 中华中医药学刊, 2017, 35(2): 373-377. Liu Y, He Y H. Research progress in molecular biology of pain mechanism [J]. Chin Arch Trad Chin Med, 2017, 35(2): 373-377.
25 中华医学会物理医学与康复学分会康复治疗学组,中国医师协会水疗康复专业委员会. 脊髓损伤水疗康复中国专家共识[J]. 中国康复理论与实践, 2019, 25(1): 34-43. Rehabilitation Therapy Section, Physical Medicine and Rehabilitation Branch, Chinese Medical Association; Chinese Medical Doctor Association Hydrotherapy Rehabilitation Professional Committee. Consensus of Chinese Experts on Spa Rehabilitation of Spinal Cord Injury [J]. Chin J Rehabil Theory Pract, 2019, 25(1): 34-43.
26 Melzack R, Wall P D. Pain mechanisms: a new theory [J]. Science, 1965, 150(3699): 971-979.
27 邵智星,吴海琴. 脑啡肽研究进展[J]. 卒中与神经疾病, 2013, 20(1): 56-58. Shao Z X, Wu H Q. Research progress of enkephalin [J]. Stroke Nerver Dis, 2013, 20(1): 56-58.
28 陈伯銮. 术后疼痛中交感神经机理[J]. 国际麻醉学与复苏杂志, 1993, 14(5): 287-288. Chen B L. Sympathetic nerve mechanism in postoperative pain [J]. Int J Anesth Resus, 1993, 14(5): 287-288.
29 马迎存,毛鹏,王海宁,等. 老年带状疱疹后神经痛患者的自主神经功能观察[J]. 中国疼痛医学杂志, 2015, 21(9): 688-691. Ma Y C, Mao P, Wang H N, et al. Observation of autonomic nerve function in elderly patients with postherpetic neuralgia [J]. Chin J Pain Med, 2015, 21(9): 688-691.
30 Akio S, Schmidt R F. The modulation of visceral functions by somatic afferent activity [J]. Jpn J Physiol, 1987, 37(1): 1-17.

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