Mens Jan M A
Department of Rehabilitation Medicine, Erasmus Medical Centre, University Medical Center, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
Best Pract Res Clin Rheumatol. 2005 Aug;19(4):609-21. doi: 10.1016/j.berh.2005.03.011.
The choice of medication for low back pain should be evidence based and tailored as much as possible to suit the individual patient. Acetaminophen (paracetamol), mild opioids and NSAIDs are the first-line drugs for low back pain but there is no evidence that one is more effective than the others. Non-benzodiazepine muscle relaxants (with or without pain medication) could be considered as second-line drugs in acute low back pain, and cyclic antidepressants in chronic low back pain. The risk of adverse side effects can be reduced by taking account of the patient's medical history and by using a test dose. The realization that symptoms other than pain are sometimes more important and/or easier to overcome can increase the benefits of medication. The long-term effects of medication can be improved when it is combined with non-drug interventions.
下背痛的药物选择应基于证据，并尽可能根据个体患者的情况进行调整。对乙酰氨基酚（扑热息痛）、轻度阿片类药物和非甾体抗炎药是下背痛的一线药物，但没有证据表明其中一种比其他药物更有效。非苯二氮䓬类肌肉松弛剂（无论是否联合止痛药物）可被视为急性下背痛的二线药物，而环类抗抑郁药可用于慢性下背痛。通过考虑患者的病史并使用试验剂量，可以降低药物不良反应的风险。认识到疼痛以外的症状有时更为重要和/或更容易克服，可提高药物治疗的益处。药物与非药物干预措施联合使用时，其长期效果会更好。
