Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians
复制标题
DOI：
10.7326/m16-2367
复制
发表时间：
2017-04-04
影响因子：
39.2
通讯作者：
Forciea, Mary Ann
中科院分区：
文献类型：
--
作者：
Qaseem, Amir;Wilt, Timothy J.;Forciea, Mary Ann
产品描述：美国内科医师学会（ACP）制定了这一指南，提出证据，并提供临床建议，对非侵入性治疗腰痛。方法：使用ACP分级系统，该委员会根据这些建议的随机，对照试验和系统评价发表到2015年4月的非侵入性药物和非药物治疗腰痛。更新检索至2016年11月。评估的临床结果包括腰痛的减轻或消除、背部特异性和整体功能的改善、健康相关生活质量的改善、工作残疾和重返工作的减少、整体改善、背痛发作次数或发作间隔时间、患者满意度和不良反应。目标受众和患者人群：本指南的目标受众包括所有临床医生，目标患者人群包括患有急性、亚急性或慢性腰痛的成人。建议1：考虑到大多数急性或亚急性腰痛患者无论治疗如何都会随着时间的推移而改善，临床医生和患者应选择非药物治疗，包括浅表热疗（中等质量证据）、按摩、针灸或脊柱推拿（低质量证据）。如果需要药物治疗，临床医生和患者应选择非甾体抗炎药或骨骼肌松弛剂（中等质量证据）。（等级：建议2：对于慢性腰痛患者，临床医生和患者最初应选择非药物治疗，包括运动、多学科康复、针灸、基于正念的减压（中等质量证据）、太极拳、瑜伽、运动控制运动、渐进式放松、肌电图生物反馈、低水平激光治疗、手术治疗、认知行为治疗、或脊柱操作（低质量证据）。（等级：强烈建议）建议3：对于非药物治疗反应不充分的慢性腰痛患者，临床医生和患者应考虑将非甾体抗炎药作为一线药物治疗，或将曲马多或度洛沙汀作为二线治疗。临床医生只应考虑阿片类药物作为上述治疗失败的患者的一种选择，只有当潜在的好处超过个体患者的风险，并在与患者讨论已知的风险和现实的好处。（等级：弱推荐，中等质量证据）
Description: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain.Methods: Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects.Target Audience and Patient Population: The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute, subacute, or chronic low back pain.Recommendation 1: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)Recommendation 2: For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)Recommendation 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence)