预防和治疗腰部疼痛:证据,挑战和有希望的方向
Nadine E Foster1, Johannes R Anema2, Dan Cherkin3
1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
Lancet (London, England)
|March 26, 2018
概括
对腰痛的临床指南建议使用非药物治疗和谨慎使用药物. 然而,全球实践的差距仍然存在,需要新的战略来有效管理和预防与背部相关的残疾.
科学领域:
- 医疗服务研究
- 肌肉骨系统疾病
- 公共卫生
背景情况:
- 对腰部疼痛的临床实践指南建议采用类似的评估和治疗策略.
- 这些包括生物心理社会框架,非药物治疗 (教育,运动) 和持续症状的心理计划.
- 建议小心使用药物,影像和手术.
研究的目的:
- 解决基于证据的建议和临床实践之间的全球差距.
- 识别和评估超越当前方法的潜在解决方案,以减少与背部相关的残疾.
- 探索实践与证据协调,促进活动和改善功能的策略.
主要方法:
- 审查高收入国家现有的临床实践指南和证据.
- 对LBP推的第一线治疗实施的全球差距的分析.
- 确定和初步评估对LBP管理和预防的有前途或新兴解决方案.
主要成果:
- 在指导方针建议和全球临床实践之间存在重大差异.
- 推的非药物治疗的使用不足,以及图像,阿片类药物和手术的过度使用是常见的.
- 目前的方法不足以减少长期的背部相关残疾.
结论:
- 调整实践与证据,减少对脊柱异常的关注,促进活动至关重要.
- 潜在的解决方案包括实施战略,重新设计的临床途径,综合健康和职业干预措施,政策变化和公共卫生倡议.
- 需要进一步的研究来验证这些战略的大规模实施.
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