Guidelines for the management of acute low back pain

项目摘要 世界卫生组织（WHO）最近报告说，腰痛（LBP）是导致 在肌肉骨骼疾病中，腰痛的患病率最高。一 据估计，在他们生命中的某个时刻，高达84%的成年人会患有LBP。虽然大多数 患有急性腰痛（ALBP）的患者经历快速改善，一些患者发展为持续性， 致残症状ALBP的治疗特点是影像学检查的多样性， 治疗，包括经常使用阿片类药物。虽然临床实践指南（CPG）建议明智地 使用阿片类药物，过度处方仍然是一个重要的关切领域，包括严重不良事件， 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; 17,000美元来自处方阿片类药物鉴于ALBP的高患病率和改善健康的潜力， 通过循证方法进行评估和管理，美国食品和药物管理局 FDA将开发用于治疗ALBP的CPG确定为优先事项。的目标 该建议是组建一个经验丰富的多学科临床研究团队， 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 关于ALBP管理的文献的系统性综述（SR）;获得循证临床实践 指导方针（CPG）;开展广泛的宣传和实施运动;并评估 CPG对知识、摄取、处方行为和短期结果的影响。 我们的目标是：具体目标#1。[第1a阶段]遵循严格、公认的透明度方法 和客观性，对有关评价的文献进行循证系统综述， 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使用透明流程制定基于证据的CPG。具体目标#3 [阶段2]传播 并通过实施工具、出版物和会议报告， 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， 媒体帖子、播客、提供者应用程序和患者旅程地图。具体目标#4 [第三阶段]评估 CPG对采用的影响，以及对知识、疼痛管理、处方实践和 利用措施。描述和分析CPG实施的障碍和促进因素。在 为了实现这些目标，我们将制定ALBP管理的CPG， FDA提供适应症特异性，适当的处方信息，用于药理学和非 药物治疗提供者社区，同时减少阿片类药物滥用和滥用。我们将 制定并记录严格的、可复制的传播和实施规程和做法 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.