Analgesic Medication Use During Exercise-Based Rehabilitation in Individuals With Low Back Pain: A Call to Action.
Analgesic Medication Use During Exercise-Based Rehabilitation in Individuals With Low Back Pain: A Call to Action.
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腰痛患者运动康复期间镇痛药物的使用：行动呼吁。
DOI：
10.1093/ptj/pzab011
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发表时间：
2021
期刊：
影响因子：
3.2
通讯作者：
Raiszadeh,Kamshad
中科院分区：
文献类型：
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作者：
Shahidi,Bahar;Schenk,Simon;Raiszadeh,Kamshad
慢性腰痛（LBP）是骨科治疗中最常见，有时也是最具挑战性的疾病之一。虽然运动康复是这一患者群体的标准治疗，但目前只有20%的患者单独参加这种类型的物理治疗。1此外，在大多数情况下，LBP管理包括以镇痛药物形式的基于疼痛的疼痛管理。这种使用镇痛剂是潜在的挑战，因为物理治疗师面临的矛盾，虽然运动镇痛药物的影响下，可以损害肌肉适应健康的人，2，3在个人疼痛，镇痛剂通常用于规避症状，限制运动耐量（图）。这种受损的适应的一个代表性例子是，在患有LBP的个体中，躯干的稳定肌肉并不一致地响应于运动而肥大，尽管力量在短期内有所改善。[4]事实上，椎旁肌肥大的缺乏被认为是导致这一人群高复发率的原因。4，5考虑到在治疗性运动中使用镇痛药的LBP患者比例很高，以及使用镇痛药对肌肉适应性、运动驱动和运动耐量的相反影响，镇痛药的使用可能是运动康复结果的根本性减损因素。然而，值得注意的是，在该领域基本上没有关于LBP患者如何使用镇痛药物相对于运动康复的客观数据。因此，该领域目前处于缺乏确切数据的情况下，可能会阻碍最佳的康复锻炼，治疗和功能adaptation.Clinical实践镇痛管理的个人与LBP有很大的不同的地理位置，诊断测试，和病人的介绍。即使从业者继续进行持续的战斗，以减少长期（> 2年疼痛持续时间）LBP患者中超过75%的阿片类药物使用率，阿片类药物仍然是该人群中最常用的处方镇痛药物。6，7阿片类药物，沿着非甾体抗炎药（NSAID），占该人群镇痛药物使用的50%以上。这很重要，
Chronic low back pain (LBP) is one of the most common, and sometimes most challenging, conditions to treat in an orthopedic setting. Though exercise-based rehabilitation is the standard of care for this patient population, only 20% of patients currently participate in this type of physical therapy in isolation. 1 Furthermore, in most cases, LBP management includes pharmacologically based pain management in the form of analgesic medications. This use of analgesics is potentially challenging, because physical therapists are faced with the paradox that, although exercise under the influence of analgesic medications can impair muscle adaptation in healthy individuals, 2, 3 in individuals with pain, analgesics are often used to circumvent symptoms that limit exercise tolerance (Figure). A representative example of this impaired adaptation is that in individuals with LBP the stabilizing muscles of the trunk do not consistently hypertrophy in response to exercise, despite short-term improvements in strength. 4 Indeed, the lack of paraspinal muscle hypertrophy is thought to contribute to the high rates of recurrence in this population. 4, 5 Given the high proportion of patients with LBP who use analgesics with therapeutic exercise, and the opposing effects of their use on muscle adaptation, motor drive, and exercise tolerance, it is possible, and perhaps likely, that analgesic use is a fundamental detractor to the outcome of exercise-based rehabilitation. Remarkably, however, there are essentially no objective data in the field on how patients with LBP use analgesic medications relative to exercise-based rehabilitation. As such, the field is currently in a situation where a lack of definitive data could be impeding optimal rehabilitative exercise, treatment, and functional adaptation.Clinical practices for analgesic management of individuals with LBP vary widely based on geography, diagnostic testing, and patient presentation. Even as practitioners continue with an ongoing battle to reduce an opioid use rate of more than 75% in patients with long-term (> 2 year pain duration) LBP, opioids remain the most frequently prescribed analgesic medication in this population. 6, 7 Opioids, along with nonsteroidal anti-inflammatory drugs (NSAIDs), account for over 50% of analgesic drug use in this population. This is significant,