Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
Spine (Phila Pa 1976). 2011 Oct 1;36(21 Suppl):S1-9. doi: 10.1097/BRS.0b013e31822f0a0d.
"Chronic" low back pain (LBP), defined as present for 3 or more months, has become a major socioeconomic problem insufficiently addressed by five major entities largely working in isolation from one another - procedural based specialties, strength based rehabilitation, cognitive behavioral therapy, pain management and manipulative care. As direct and indirect costs continue to rise, many authors have systematically evaluated the body of evidence in an effort to demonstrate the effectiveness (or lack thereof) for various diagnostic and therapeutic interventions. The objective of this Spine Focus issue is not to replicate previous work in this area. Rather, our expert panel has chosen a set of potentially controversial topics for more in-depth study and discussion. A recurring theme is that chronic LBP is a heterogeneous condition, and this affects the way it is diagnosed, classified, treated, and studied. The efficacy of some treatments may be appreciated only through a better understanding of heterogeneity of treatment effects (i.e., identification of clinically relevant subgroups with differing responses to the same treatment). Current clinical guidelines and payer policies for LBP are systematically compared for consistency and quality. Novel approaches for data gathering, such as national spine registries, may offer a preferable approach to gain meaningful data and direct us towards a "results-based medicine." This approach would require more high-quality studies, more consistent recording for various phenotypes and exploration of studies on genetic epidemiologic undertones to guide us in the emerging era of "results based medicine."
慢性下背痛（LBP）定义为持续 3 个月或以上，已成为一个重大的社会经济问题，而主要以程序为基础的专业、力量为基础的康复、认知行为疗法、疼痛管理和手法治疗这五个实体并未充分解决这一问题，它们彼此之间大多孤立运作。随着直接和间接成本的持续上升，许多作者已经系统地评估了证据体，以证明各种诊断和治疗干预的有效性（或缺乏有效性）。本期脊柱焦点的目的不是重复该领域的先前工作。相反，我们的专家小组选择了一组潜在有争议的主题进行更深入的研究和讨论。一个反复出现的主题是，慢性 LBP 是一种异质性疾病，这会影响其诊断、分类、治疗和研究方式。一些治疗方法的疗效可能只有通过更好地了解治疗效果的异质性（即，确定对同一治疗有不同反应的临床相关亚组）才能得到体现。目前针对 LBP 的临床指南和支付者政策在一致性和质量方面进行了系统比较。数据收集的新方法，如国家脊柱登记处，可能提供了一种更好的方法来获得有意义的数据，并引导我们走向“基于结果的医学”。这种方法需要更多高质量的研究，对各种表型进行更一致的记录，并探索基于遗传流行病学背景的研究，以指导我们在新兴的“基于结果的医学”时代。
