Hall Hamilton, McIntosh Greg
CBIHealth, Toronto, Canada.
BMJ Clin Evid. 2008 Oct 3;2008:1102.
Low back pain (LBP) affects about 70% of people in resource-rich countries at some point. Acute low back pain is usually perceived as self-limiting; however, one year later, as many as 33% of people still have moderate-intensity pain and 15% have severe pain. It has a high recurrence rate; 75% of those with a first episode have a recurrence. Although acute episodes may resolve completely, they may also increase in severity and duration over time.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatments for low back pain? What are the effects of local injections for low back pain? What are the effects of non-drug treatments for low back pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 34 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics (paracetamol, opioids), back exercises, back schools, bed rest, behavioural therapy, electromyographic biofeedback, epidural corticosteroid injections, lumbar supports, massage, multidisciplinary treatment programmes, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), spinal manipulation (in the short term), temperature treatments (short wave diathermy, ultrasound, ice, heat), traction, and transcutaneous electrical nerve stimulation (TENS).
在资源丰富的国家，约70%的人在某个阶段会受到腰痛（LBP）的影响。急性腰痛通常被认为是自限性的；然而，一年后，仍有多达33%的人有中度疼痛，15%的人有重度疼痛。其复发率很高；首次发作的患者中有75%会复发。虽然急性发作可能会完全缓解，但随着时间的推移，其严重程度和持续时间也可能增加。
我们进行了一项系统评价，旨在回答以下临床问题：口服药物治疗腰痛的效果如何？局部注射治疗腰痛的效果如何？非药物治疗腰痛的效果如何？我们检索了：截至2007年5月的Medline、Embase、Cochrane图书馆及其他重要数据库（临床证据综述会定期更新，请查看我们的网站以获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品和医疗产品监管局（MHRA）等相关组织的危害警示。
我们找到了34项符合我们纳入标准的系统评价、随机对照试验或观察性研究。我们对干预措施的证据质量进行了GRADE评估。
在本系统评价中，我们提供了以下干预措施的有效性和安全性相关信息：针灸、保持活动的建议、镇痛药（对乙酰氨基酚、阿片类药物）、背部锻炼、背部学校、卧床休息、行为疗法、肌电图生物反馈、硬膜外皮质类固醇注射、腰部支撑、按摩、多学科治疗方案、肌肉松弛剂、非甾体抗炎药（NSAIDs）、脊柱推拿（短期）、温度治疗（短波透热疗法、超声、冰敷、热敷）、牵引和经皮电刺激神经疗法（TENS）。
