Itz Coen J, Willems Paul C, Zeilstra Dick J, Huygen Frank J
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Health Insurance Company VGZ Eindhoven, Eindhoven, The Netherlands.
Pain Pract. 2016 Jan;16(1):90-110. doi: 10.1111/papr.12318. Epub 2015 Jun 1.
When conservative therapies such as pain medication or exercise therapy fail, invasive treatment may be indicated for patients with lumbosacral spinal pain. The Dutch Society of Anesthesiologists, in collaboration with the Dutch Orthopedic Association and the Dutch Neurosurgical Society, has taken the initiative to develop the guideline "Spinal low back pain," which describes the evidence regarding diagnostics and invasive treatment of the most common spinal low back pain syndromes, that is, facet joint pain, sacroiliac joint pain, coccygodynia, pain originating from the intervertebral disk, and failed back surgery syndrome.
The aim of the guideline is to determine which invasive treatment intervention is preferred for each included pain syndrome when conservative treatment has failed. Diagnostic studies were evaluated using the EBRO criteria, and studies on therapies were evaluated with the Grading of Recommendations Assessment, Development and Evaluation system. For the evaluation of invasive treatment options, the guideline committee decided that the outcome measures of pain, function, and quality of life were most important.
The definition, epidemiology, pathophysiological mechanism, diagnostics, and recommendations for invasive therapy for each of the spinal back pain syndromes are reported.
The guideline committee concluded that the categorization of low back pain into merely specific or nonspecific gives insufficient insight into the low back pain problem and does not adequately reflect which therapy is effective for the underlying disorder of a pain syndrome. Based on the guideline "Spinal low back pain," facet joint pain, pain of the sacroiliac joint, and disk pain will be part of a planned nationwide cost-effectiveness study.
当止痛药物或运动疗法等保守治疗无效时，可能需要对腰骶部脊柱疼痛患者进行侵入性治疗。荷兰麻醉医师协会与荷兰骨科协会和荷兰神经外科学会合作，主动制定了“脊柱下腰痛”指南，该指南描述了关于最常见的脊柱下腰痛综合征（即小关节疼痛、骶髂关节疼痛、尾骨痛、椎间盘源性疼痛和腰椎手术失败综合征）的诊断和侵入性治疗的证据。
该指南的目的是确定当保守治疗失败时，对于每种纳入的疼痛综合征，哪种侵入性治疗干预是首选的。诊断性研究使用EBRO标准进行评估，治疗研究使用推荐分级评估、制定和评价系统进行评估。为了评估侵入性治疗方案，指南委员会决定疼痛、功能和生活质量的结局指标最为重要。
报告了每种脊柱下腰痛综合征的定义、流行病学、病理生理机制、诊断和侵入性治疗建议。
指南委员会得出结论，将下腰痛仅分为特定性或非特定性，对下腰痛问题的了解不足，也不能充分反映哪种治疗对疼痛综合征的潜在疾病有效。基于“脊柱下腰痛”指南，小关节疼痛、骶髂关节疼痛和椎间盘疼痛将成为一项计划中的全国性成本效益研究的一部分。
