Guidelines for the management of acute low back pain

项目摘要 世界卫生组织(WHO)最近报告称，下腰痛(LBP)是主要原因 在全球范围内，残疾患病率最高；在肌肉骨骼疾病中，腰痛的患病率最高。一 据估计，在他们一生中的某个时候，高达84%的成年人会患上LBP。尽管大多数 急性下腰痛(ALBP)患者病情迅速改善，一些患者出现持续性症状， 使症状失效。ALBP的管理特点是在使用成像和 治疗，包括经常使用阿片类药物。虽然临床实践指南(CPGs)推荐明智的 阿片类药物的使用、过度处方仍然是一个重要的令人关切的领域，包括严重的不良事件 如吸毒过量和阿片类药物使用障碍。2017年，估计有47,600名美国人死于阿片类药物过量； 来自处方阿片类药物的17,000人。鉴于ALBP的高患病率和改善健康的潜力 通过循证评估和管理的结果，美国食品和药物管理局 美国食品和药物管理局(FDA)将开发治疗ALBP的CPGs确定为优先事项。的目标是 这项建议是为了组建一支经验丰富的、多学科的临床研究团队， 方法学家、提供者、医疗保健系统、付款人和患者代表进行严格的 系统回顾(SR)有关ALBP治疗的文献；循证临床实践 指导方针(CPGs)；开展广泛的传播和实施运动；以及评估 CPGs对知识、摄取、处方行为和短期结果的影响。 我们的具体目标是：具体目标1.[阶段1a]遵循严格、公认的透明度方法 和客观性，对关于评价和评价的文献进行循证的系统审查 ALBP的管理，包括使用阿片类药物的好处和危害。具体目标2.[阶段1b]利用 SR使用透明的过程来开发基于证据的CPG。具体目标3.[第二阶段]传播 并通过执行工具、出版物和对会议的介绍来执行《公约》， 专业协会、医疗保健系统、付款人和患者/倡导团体；并通过网络研讨会、社会 媒体帖子、播客、提供商应用程序和患者旅程地图。具体目标4.[阶段3]评估 CPG对采用的影响，以及对知识、疼痛管理、处方做法和 利用的措施。描述和分析实施CPG的障碍和促进者。在……里面 为了实现这些目标，我们将为ALBP的管理产生一个CPG，这将有助于实现以下目标 FDA为药物和非药物提供特定适应症的适当处方信息 为提供者社区提供药物治疗，同时减少阿片类药物的滥用和滥用。我们会 建立并记录严格和可重复的传播和实施方案和做法 这可用于未来的CPG项目。

Project Summary The World Health Organization (WHO) recently reported that low back pain (LBP) is the leading cause of disability globally; among musculoskeletal conditions LBP accounts for the highest prevalence. One estimate indicates that at some point in their lives, up to 84% of adults will suffer from LBP. Although most patients with acute low back pain (ALBP) experience rapid improvement, some patients develop persistent, disabling symptoms. Management of ALBP has been characterized by variability in use of imaging and treatments, including frequent use of opioids. While clinical practice guidelines (CPGs) recommend judicious use of opioids, overprescribing remains an important area of concern, including serious adverse events such as overdose and opioid use disorder. In 2017, an estimated 47,600 Americans died from opioid overdose; 17,000 from prescription opioids. Given the high prevalence of ALBP and the potential to improve health outcomes through evidence-based approaches to evaluation and management, the U.S. Food and Drug Administration (FDA) identified the development of CPGs for treatment of ALBP as a priority. The objective of this proposal is to assemble a highly experienced, multidisciplinary team of clinical investigators, methodologists, providers, healthcare systems, payers, and patient representatives to conduct a rigorous systematic review (SR) of the literature about management of ALBP; derive evidence-based clinical practice guidelines (CPGs); conduct a wide-ranging dissemination and implementation campaign; and evaluate the impact of the CPGs on knowledge, uptake, prescribing behavior, and short-term outcomes. Our specific aims are: Specific Aim #1. [Phase 1a] Following rigorous, accepted methodology for transparency and objectivity, conduct an evidence-based systematic review of the literature on the evaluation and management of ALBP, including the benefits and harms of use of opioids. Specific Aim #2. [Phase 1b] Utilizing the SR, develop an evidence-based CPG using a transparent process. Specific Aim #3. [Phase 2] Disseminate and implement the CPG, through implementation tools; publications and presentations to conferences, specialty societies, healthcare systems, payers, and patient/advocacy groups; and through webinars, social media posts, podcasts, a provider app, and a patient journey map. Specific Aim #4. [Phase 3] Evaluate the impact of the CPG on adoption, and on changes in knowledge, pain management, prescribing practices, and measures of utilization. Describe and analyze barriers to and facilitators of CPG implementation. In accomplishing these aims, we will produce a CPG for management of ALBP that will contribute to the goals of the FDA to provide indication-specific, appropriate prescribing information for pharmacologic and non- pharmacologic treatments to the provider communities, while reducing opioid misuse and abuse. We will establish and document rigorous and reproducible dissemination and implementation protocols and practices that can be used for future CPG projects.