Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach.
Evidence-based interventions to treat chronic low back pain: treatment selection for a personalized medicine approach.
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DOI：
10.1097/pr9.0000000000001019
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发表时间：
2022-09
期刊：
影响因子：
4.8
通讯作者：
中科院分区：
文献类型：
--
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综述了目前慢性下腰痛(CLBP)治疗方法的文献，并推荐将4种干预措施纳入一项多点慢性下腰痛临床试验。慢性下腰痛(CLBP)在美国和全球非常普遍，导致功能障碍和生活质量下降。虽然治疗慢性下腰痛的方法很多，但临床医生对哪种特定疗法(S)对个别患者或患者亚组最有效的信息很少。背痛研究联盟是美国国立卫生研究院帮助结束成瘾长期康复计划的一部分，该联盟将进行一项合作临床试验，旨在开发一种个性化的药物算法，以优化cLBP患者的患者和提供者的治疗选择。本文的主要目的是提供循证cLBP干预措施的最新进展，并描述审查和选择纳入临床试验的干预措施的过程。一个由cLBP专家组成的工作组审查并选择了纳入临床试验的干预措施。主要评价指标为证据强度和治疗效果大小。在文献中，考虑了疗效持续时间、起效时间、遗留效应、多模式疗效、反应者亚群以及治疗效果机制或生物标志物的证据。工作组选择了4种主要的循证治疗方法，用于慢性腰痛的临床试验和常规临床治疗。这些治疗包括(1)度洛西汀，(2)接受和承诺治疗，(3)基于分类的运动和手动治疗干预，以及(4)自我管理方法。这些干预措施都有中到高水平的证据来支持一种治疗效果，并且来自不同的治疗类别。
Literature on current treatments for chronic low back pain (cLBP) were reviewed and 4 interventions were recommended for inclusion in a multisite cLBP clinical trial. Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research Consortium, part of the National Institutes of Health Helping to End Addiction Long-termSM (HEAL) Initiative, will conduct a collaborative clinical trial, which seeks to develop a personalized medicine algorithm to optimize patient and provider treatment selection for patients with cLBP. The primary objective of this article is to provide an update on evidence-based cLBP interventions and describe the process of reviewing and selecting interventions for inclusion in the clinical trial. A working group of cLBP experts reviewed and selected interventions for inclusion in the clinical trial. The primary evaluation measures were strength of evidence and magnitude of treatment effect. When available in the literature, duration of effect, onset time, carryover effect, multimodal efficacy, responder subgroups, and evidence for the mechanism of treatment effect or biomarkers were considered. The working group selected 4 leading, evidence-based treatments for cLBP to be tested in the clinical trial and for use in routine clinical treatment. These treatments include (1) duloxetine, (2) acceptance and commitment therapy, (3) a classification-based exercise and manual therapy intervention, and (4) a self-management approach. These interventions each had a moderate to high level of evidence to support a therapeutic effect and were from different therapeutic classes.