Review of UK data on the rheumatic diseases--7. Low back pain.
Review of UK data on the rheumatic diseases--7. Low back pain.
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英国风湿病数据回顾--7。
DOI：
10.1093/rheumatology/30.3.208
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
A. Rigby
中科院分区：
文献类型：
--
作者：
A. Papageorgiou;A. Rigby
背痛是英国人最常见的症状之一，也是人们最不了解的症状之一。在大多数风湿性疾病的诊断标准上有普遍的共识;背痛的情况并非如此，这可能反映了它作为症状而不是诊断的状态。即使在官方的政府统计数据中，也没有关于背痛的定义（见附录）。由于调查中的大多数人没有区分不同的背痛原因，在审查现有数据时，本文考虑了腰痛（LBP）的所有原因，包括背部拉伤。颈椎疾病虽然非常常见[1]，但不包括在内，强直性脊柱炎（AS）单独考虑。对于接受全科治疗的急性背痛男性患者，典型数据表明，11%是由于紧张，8%是椎间盘疾病，79%是无明显原因;女性患者的相应数字分别为4%，6%和89%[2]。LBP的转诊率由全科医生（GP）到医院的差异很大，这取决于潜在的诊断，和一个类似的选择过程可能发生在个人决定是否咨询他们的家庭医生。因此，上述报告的诊断分布不一定反映社区实际发生的情况。LBP的发作性质，可能从剧烈运动后的偶尔刺痛到急性发作再到慢性背痛，也使得这种症状的流行病学评估变得困难[3]。在这篇综述中，我们试图对人群中腰痛的总体情况进行描述。患病率一般人群中腰痛的患病率从18%到26%不等[4-6]。Biering-Sorensen [7]报告1年期间的患病率高达45%。患病率的变化可以通过数据收集、问题制定和时间规定的差异来解释。图1显示了人群中背痛的典型年龄-性别患病率，女性的患病率始终高于男性，两者都在中年达到峰值。腰椎间盘突出症的病因随年龄而变化，椎间盘疾病、背部劳损和创伤在年轻人群（尤其是45岁以下的男性）中更常见，椎间盘退变在45岁以上的人群中更常见[3，8，9]。值得关注的是，老年人背痛的相对下降，因为脊柱的X线摄影变化在该组中几乎是普遍的[3，10];考虑到老年人更频繁地报告其他关节疼痛，不太可能存在漏报[11]。比较
BACK pain is one of the most common symptoms experienced by the British population; it is also one of the least understood. In most rheumatic disorders there is general consensus on diagnostic criteria; that this is not the case for back pain probably reflects its status as a symptom not a diagnosis. Even in official government statistics, there is no agreement on what constitutes back pain (see Appendix). As most individuals in surveys do not differentiate between different causes of back pain, in reviewing the available data this paper considers all causes of low back pain (LBP), including back strain. Disorders of the cervical spine, although very frequent [1], are not included and ankylosing spondylitis (AS) is considered separately.* For male patients attending general practice with acute back pain, typical figures suggest that 11% were due to strain, 8% disc disorder and in 79% no cause was evident; the equivalent figures for female patients being 4%, 6% and 89%[2]. The referral rate of LBP by general practitioners (GP) to hospital varied considerably depending on the underlying diagnosis, and a similar selection process probably takes place when individuals decide whether or not to consult their GP. Thus the distribution of diagnoses reported above will not necessarily reflect those actually occurring in the community. The episodic nature of LBP, which may range from the occasional twinge after heavy exertion to acute episodes to chronic back pain, also makes an epidemiological assessment of this symptom difficult [3]. In this review a general picture of low back pain in the population is attempted.PREVALENCE Point prevalence rates for LBP in the general population range from 18% to 26%[4-6]. Biering-Sorensen [7] reports a 1-year period prevalence as high as 45%. The variation in prevalence rates could be explained by the differences in data collection, question formulation, and time specification. Figure 1 illustrates typical age-sex prevalence rates for back pain in the population, with women showing consistently higher rates than men, and both peaking in middle age. The cause of LBP varies with age, with disc disorders, back strain and trauma being more common in the younger age groups (especially males under 45) and disc degeneration common in those aged over 45 [3, 8, 9]. The comparative decline of back pain in the elderly is of interest as radiographical changes of the spine are almost universal in this group [3, 10]; there is unlikely to be underreporting given that pain in other joints is reported more frequently by the elderly [11]. Comparison of