Kalso Eija, Allan Laurie, Dobrogowski Jan, Johnson Martin, Krcevski-Skvarc Nevenka, Macfarlane Gary J, Mick Gérard, Ortolani Sergio, Perrot Serge, Perucho Alfredo, Semmons Ian, Sörensen Jan
Pain Clinic, Helsinki University Central Hospital, Helsinki, Finland.
Curr Med Res Opin. 2005 Nov;21(11):1819-28. doi: 10.1185/030079905X65303.
Since chronic low back pain (CLBP) is a complex biopsychosocial problem the ideal treatment is multimodal and multidisciplinary. However, in many countries, primary-care physicians care for many people with CLBP and have a pivotal role in selecting patients for more intensive treatments when these are available. Guidelines on the general use of strong opioids in chronic non-cancer pain have been published but, until now, no specific guidelines were available on their use in chronic low back pain. Given the prevalence of CLBP, and the complex nature of this multifactorial condition, it was felt that specific, evidence-based recommendations, with a focus on primary-care treatment, would be helpful.
An expert panel drawn from across Europe including pain specialists, anaesthetists, neurologists, rheumatologists, a general practitioner, an epidemiologist and the chairman of a pain charity was therefore convened. The aim of the group was to develop evidence-based recommendations that could be used as a framework for more specific guidelines to reflect local differences in the availability of specialist pain services and in the legal status and availability of strong opioids. Statements were based on published evidence (identified by a literature search) wherever possible, and supported by clinical experience when suitable evidence was lacking.
Strong opioids have a role in the treatment of low back pain when other treatments have failed. They should be prescribed as part of a multimodal, and ideally interdisciplinary, treatment plan. The aim of treatment should be to relieve pain and facilitate rehabilitation.
由于慢性下腰痛（CLBP）是一个复杂的生物心理社会问题，理想的治疗方法是多模式和多学科的。然而，在许多国家，初级保健医生诊治众多慢性下腰痛患者，并且在有更强化治疗手段时，他们在挑选患者接受这些治疗方面起着关键作用。关于在慢性非癌性疼痛中普遍使用强效阿片类药物的指南已经发布，但到目前为止，尚无关于其在慢性下腰痛中使用的具体指南。鉴于慢性下腰痛的患病率以及这种多因素疾病的复杂性，人们认为制定以初级保健治疗为重点的、基于证据的具体建议会有所帮助。
因此召集了一个来自欧洲各地的专家小组，成员包括疼痛专家、麻醉师、神经科医生、风湿病学家、一名全科医生、一名流行病学家以及一家疼痛慈善机构的主席。该小组的目的是制定基于证据的建议，这些建议可作为更具体指南的框架，以反映专科疼痛服务可及性、强效阿片类药物的法律地位和可及性方面的地区差异。陈述尽可能基于已发表的证据（通过文献检索确定），在缺乏合适证据时由临床经验提供支持。
当其他治疗方法失败时，强效阿片类药物在治疗下腰痛中具有一定作用。它们应作为多模式且理想情况下是跨学科治疗计划的一部分来开具处方。治疗的目的应是缓解疼痛并促进康复。
