Low back pain (non-specific)
Low back pain (non-specific)
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DOI：
10.1016/j.berh.2006.08.004
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发表时间：
2007-02-01
影响因子：
5.2
通讯作者：
van Tulder, M.
中科院分区：
文献类型：
--
作者：
Krismer, M.;van Tulder, M.
下背痛（LBP）定义为第12肋骨和臀下襞之间的疼痛，伴或不伴腿部疼痛。大多数情况下是非特异性的，但在约10%的情况下，确定了特定的原因。红旗是通常与特定LBP相关的典型体征或症状。黄旗是与疾病的更不利和通常慢性致残过程相关的预后因素。LBP的终生患病率为60- 85%。在任何时候，大约15%的成年人患有LBP。腰痛对社会造成经济负担，主要是损失大量工作日（间接费用），直接治疗费用较少。已发现相当大比例的慢性LBP患者患有慢性广泛性疼痛。LBP通常与其他疼痛表现有关，如头痛，腹痛和四肢不同部位的疼痛。与局限性腰痛相比，广泛性疼痛与更差的预后相关。治疗目标是减轻疼痛和更好的活动/参与，包括预防残疾以及提高工作能力。从选择和评价指南，系统评价和主要临床研究的证据分为四个级别，第一级是最好的水平与随机对照试验的荟萃分析的证据。关键建议（第一级）：健身计划和建议保持活跃，可以减少疼痛，改善功能，并可以防止LBP成为慢性。简单的止痛药、NSAID和肌肉松弛剂可以减轻疼痛，改善和维持功能。保持体力活动，避免休息和手动治疗可以减轻疼痛，维持和恢复急性LBP的功能。行为治疗可以防止LBP成为慢性病。有氧健身和耐力训练，行为治疗和多学科治疗计划可以减轻疼痛，并可以改善/维持慢性LBP的功能。
Low back pain (LBP) is defined as pain localised between the 12th rib and the inferior gluteal folds, with or without leg pain. Most cases are non-specific, but in about 10% of cases a specific cause is identified. Red flags are typical signs or symptoms that are frequently associated with specific LBP. Yellow flags are prognostic factors associated with a more unfavourable and often chronic disabling course of the disease. LBP has a lifetime prevalence of 60-85%. At any one time, about 15% of adults have LBP. LBP poses an economic burden to society, mainly in terms of the large number of work days lost (indirect costs) and less so by direct treatment costs. A substantial proportion of individuals with chronic LBP has been found to have chronic widespread pain. LBP is often associated with other pain manifestations such as headache, abdominal pain and pain in different locations of the extremities. Widespread pain is associated with a worse prognosis compared to localised LBP.Treatment targets are reduction of pain and better activity/participation, including prevention of disability as well as maintainance of work capacity. The evidence from selected and appraised guidelines, systematic reviews and major clinical studies was classified into four levels, level la being the best level with evidence from meta-analysis of randomised controlled trials.Key recommendations (level Ia): fitness programmes and advice to stay active can reduce pain, improve function and can prevent LBP becoming chronic. Simple analgesics, NSAIDs and muscle relaxants can reduce pain and can improve and maintain function. Maintaining physical activity, avoiding rest and manual therapy can reduce pain and maintain and restore function in acute LBP. Behavioural treatment can prevent LBP becoming chronic. Aerobic fitness and endurance training, behavioural treatment and multi-disciplinary treatment programmes can reduce pain and can improve/maintain function in chronic LBP.