美国国立卫生研究院慢性腰痛研究标准特别工作组重点文章报告。
Focus article report of the NIH task force on research standards for chronic low back pain.
作者信息
Deyo Richard A, Dworkin Samuel F, Amtmann Dagmar, Andersson Gunnar, Borenstein David, Carragee Eugene, Carrino John A, Chou Roger, Cook Karon, DeLitto Anthony, Goertz Christine, Khalsa Partap, Loeser John, Mackey Sean, Panagis James, Rainville James, Tosteson Tor, Turk Dennis, Von Korff Michael, Weiner Debra K
机构信息
*Oregon Health and Sciences University, Portland, Oregon †University of Washington, Seattle, Washington ‡Rush University Medical Center, Chicago, Illinois §George Washington University, Washington, District of Columbia ∥Stanford University, Stanford, California ¶Johns Hopkins University, Baltimore, Maryland #Northwestern University, Evanston, Illinois **VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania ††Palmer College of Chiropractic, Davenport, Iowa ‡‡National Center for Complementary and Alternative Medicine, Bethesda, Maryland §§National Institute for Arthritis, Musculoskeletal and Skin Diseases, Bethesda, Maryland ∥∥New England Baptist Hospital, Roxbury Crossing, Massachusetts ¶¶Dartmouth University, Hanover, New Hampshire ##Group Health Research Institute, Seattle, Washington.
出版信息
Clin J Pain. 2014 Aug;30(8):701-12. doi: 10.1097/AJP.0000000000000120.
BACKGROUND
Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus.
METHODS
The NIH Pain Consortium therefore charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel developed a 3-stage process, each with a 2-day meeting.
RESULTS
The panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals.
CONCLUSIONS
The RTF believes these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement.
背景
尽管干预措施迅速增加，但近几十年来，慢性腰痛（cLBP）导致的功能残疾却有所增加。我们常常无法确定能够解释cLBP对患者生活产生重大负面影响的机制。这种cLBP通常被称为非特异性的，可能是由多种生物学和行为学病因引起的。研究人员使用不同的纳入标准、定义、基线评估和结局指标，这阻碍了比较和达成共识。
方法
因此，美国国立卫生研究院疼痛协会责成一个研究特别工作组（RTF）起草cLBP的研究标准。由此产生的多学科小组制定了一个三阶段流程，每个阶段都有为期两天的会议。
结果
该小组建议使用两个问题来定义cLBP；根据其影响（由疼痛强度、疼痛干扰和身体功能定义）对cLBP进行分类；使用最小数据集来描述研究参与者（大量借鉴患者报告结果测量信息系统（PROMIS）方法）；除了平均结局分数外，报告“反应者分析”；以及对未来研究和传播的建议。疼痛协会已批准这些建议，研究人员应将其纳入美国国立卫生研究院的资助申请中。
结论
RTF认为这些建议将推动该领域的发展，有助于解决争议，并促进未来针对慢性腰痛的基因组、神经学和其他机制基础的研究。报告的更大一致性应有助于研究之间的比较和表型的发展。我们预计RTF的建议将成为一份动态文件，并不断改进。
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