George Washington University Medical Centre, Arthritis and Rheumatism Associates, 2021 K Street, NW Suite 300, Washington, DC 20006, USA.
Nat Rev Rheumatol. 2013 Nov;9(11):643-53. doi: 10.1038/nrrheum.2013.133. Epub 2013 Sep 10.
Low back pain, in its acute and chronic forms, is one of the most common health problems and is frequently evaluated by rheumatologists. The multiple possible diagnoses associated with this symptom make correctly attributing back pain to a specific disease difficult. This dilemma necessitates an organized approach to separate patients with mechanical disorders from those with rare systemic disorders. The most common forms of back pain are mechanical. Gradual modifications in the axial skeletal structures over time result in pathological disorders that generally occur later in an individual's lifespan. The diagnostic process that identifies these mechanical disorders is straightforward and does not require expensive radiological or laboratory tests in the early phases of the evaluation. Most low back pain resolves without intervention, but some reports suggest that episodes of back pain are persistent or recurring for a substantial minority of patients. Therapies for back pain can be nonpharmacological, pharmacological or surgical. All interventions have limited capacity to resolve low back pain. Nonsurgical therapies are preferred for muscle injuries and osteoarthritis of the lumbar spine. Surgical interventions can resolve the pain and dysfunction of disc herniation and spinal stenosis more rapidly than conventional therapy, but surgical benefit wanes over time.
下背痛，包括急性和慢性形式，是最常见的健康问题之一，经常由风湿病学家进行评估。与该症状相关的多种可能的诊断使得将背痛归因于特定疾病变得困难。这种困境需要一种有组织的方法，将患有机械性疾病的患者与患有罕见系统性疾病的患者区分开来。最常见的下背痛形式是机械性的。随着时间的推移，轴向骨骼结构的逐渐变化会导致病理紊乱，这些紊乱通常在个体生命后期发生。识别这些机械性疾病的诊断过程很简单，在评估的早期阶段不需要昂贵的影像学或实验室检查。大多数下背痛无需干预即可自行缓解，但有一些报告表明，相当一部分患者的背痛持续或反复发作。下背痛的治疗方法可以是非药物治疗、药物治疗或手术治疗。所有干预措施都只能有限地缓解下背痛。非手术治疗是肌肉损伤和腰椎骨关节炎的首选治疗方法。手术干预可以比传统治疗更快地解决椎间盘突出症和椎管狭窄症的疼痛和功能障碍，但随着时间的推移，手术的益处会逐渐减弱。
