Department of Physical Medicine and Rehabilitation, University of Washington Medical Center, Seattle, WA, USA.
Curr Rev Musculoskelet Med. 2009 Jun;2(2):94-104. doi: 10.1007/s12178-009-9051-x. Epub 2009 Mar 25.
Low back pain (LBP) affects approximately 60-85% of adults during some point in their lives. Fortunately, for the large majority of individuals, symptoms are mild and transient, with 90% subsiding within 6 weeks. Chronic low back pain, defined as pain symptoms persisting beyond 3 months, affects an estimated 15-45% of the population. For the minority with intractable symptoms, the impact on quality of life and economic implications are considerable. Despite the high prevalence of low back pain within the general population, the diagnostic approach and therapeutic options are diverse and often inconsistent, resulting in rising costs and variability in management throughout the country. In part, this is due to the difficulty establishing a clear etiology for most patients, with known nociceptive pain generators identified throughout the axial spine. Back pain has been termed as "an illness in search of a disease." Indeed, once "red flag" diagnoses such as cancer and fracture have been ruled out, the differential sources of low back pain remain broad, including the extensive realm of degenerative changes within the axial spine for which radiological evaluation is nonspecific and causal relationships are tentative. We will elaborate on these degenerative processes and their clinical implications. We will further discuss diagnostic approaches and the efficacy of existing treatment options.
下背痛（LBP）在其生命中的某个时刻影响约 60-85%的成年人。幸运的是，对于大多数人来说，症状是轻微和短暂的，90%的人在 6 周内消退。慢性下背痛定义为疼痛症状持续超过 3 个月，估计影响 15-45%的人口。对于少数有顽固性症状的人来说，对生活质量和经济的影响是相当大的。尽管在一般人群中低背痛的发病率很高，但诊断方法和治疗选择多种多样，而且往往不一致，导致全国范围内的管理成本上升和变异性增加。部分原因是由于大多数患者难以确定明确的病因，在整个脊柱中都发现了已知的伤害性疼痛发生源。背痛被称为“寻找疾病的疾病”。事实上，一旦排除了“红旗”诊断，如癌症和骨折，下背痛的潜在来源仍然很广泛，包括轴向脊柱内广泛的退行性变化，影像学评估是非特异性的，因果关系也不确定。我们将详细阐述这些退行性过程及其临床意义。我们将进一步讨论诊断方法和现有治疗方案的疗效。
