Reis S, Hermoni D, Borkan J M, Biderman A, Tabenkin C, Porat A
Department of Family Medicine, Technion, Institute of Technology, Bruce Rappaport Faculty of Medicine, Haifa, Israel.
J Fam Pract. 1999 Apr;48(4):299-303.
Low back pain (LBP) is one of the most frequent reasons patients seek consultations in primary care, and it is a major cause of disability. Our research examines the natural history of LBP and the prediction of chronicity in the context of patients presenting to family medicine clinics.
We performed a prospective cohort study of new episodes of LBP within the framework of a national family practice research network. The setting was 28 primary care family practice clinics located throughout Israel. Of 238 eligible subjects, 219 (92%) completed the study.
During the 2-month study period, 2 subjects were referred to the emergency department and discharged, and 2 others were hospitalized. Forty-five percent did not require bed rest, and 38% of the employed were not absent from work. Seventy-one percent showed improvement in functional status; however, only 37% noted complete pain relief. Clinical and demographic data usually did not predict LBP-episode outcomes. The strongest predictors of chronicity were depression, history of job change due to LBP in the past, history of back contusion, lack of social support, family delegitimization of patient's pain, dissatisfaction with first office visit, family history of LBP or other chronic pain, coping style, and unemployment.
The cohort patients displayed a relatively benign natural history of LBP, matched by benign clinical behavior from their physicians. In Israeli primary health care, acute LBP is infrequently associated with hospitalization or prolonged work absenteeism. Although most patients have functional improvement, pain often lingers. Almost all predictors of chronicity are psychosocial.
腰痛（LBP）是患者在初级保健中寻求咨询的最常见原因之一，也是导致残疾的主要原因。我们的研究在家庭医学诊所就诊的患者背景下，研究了腰痛的自然病史和慢性化的预测因素。
我们在一个国家家庭医疗研究网络的框架内，对腰痛新发病例进行了一项前瞻性队列研究。研究地点为以色列各地的28家初级保健家庭医疗诊所。在238名符合条件的受试者中，219名（92%）完成了研究。
在为期2个月的研究期间，2名受试者被转诊至急诊科并出院，另有2人住院。45%的患者不需要卧床休息，38%的在职患者没有缺勤。71%的患者功能状态有所改善；然而，只有37%的患者表示疼痛完全缓解。临床和人口统计学数据通常无法预测腰痛发作的结果。慢性化的最强预测因素包括抑郁、过去因腰痛而换工作的历史、背部挫伤史、缺乏社会支持、家人对患者疼痛的不当质疑、对首次门诊不满意、腰痛或其他慢性疼痛的家族史、应对方式以及失业。
队列中的患者腰痛自然病史相对良好，医生的临床行为也较为温和。在以色列初级卫生保健中，急性腰痛很少与住院或长期旷工相关。虽然大多数患者功能有所改善，但疼痛往往持续存在。几乎所有慢性化的预测因素都是社会心理因素。
