Deyo Richard A, Mirza Sohail K, Turner Judith A, Martin Brook I
Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
J Am Board Fam Med. 2009 Jan-Feb;22(1):62-8. doi: 10.3122/jabfm.2009.01.080102.
Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.
慢性背痛是患者最常见的主诉之一。其患病率和影响催生了一系列迅速扩展的检查和治疗方法。其中一些已被广泛用于未经充分验证的适应症，导致疗效和安全性存在不确定性，并发症发生率增加以及市场滥用。最近的研究表明，医疗保险用于硬膜外类固醇注射的支出增加了629%；用于治疗背痛的阿片类药物支出增加了423%；医疗保险受益人中腰椎磁共振成像的数量增加了307%；脊柱融合手术率增加了220%。现有有限的研究表明，这些增加并未伴随着患者结局或残疾率在人群层面的改善。我们建议需要更好地理解疼痛机制的基础科学，对许多治疗方法进行更严格和独立的试验，对慢性疼痛新药和器械的批准及上市后监测采取更强有力的监管立场，以及采用慢性病模式来管理慢性背痛。
