From Oregon Health and Science University, Portland, Oregon, and University of Washington, Seattle, and Spectrum Research, Tacoma, Washington.
Ann Intern Med. 2017 Apr 4;166(7):493-505. doi: 10.7326/M16-2459. Epub 2017 Feb 14.
BACKGROUND: A 2007 American College of Physicians guideline addressed nonpharmacologic treatment options for low back pain. New evidence is now available. PURPOSE: To systematically review the current evidence on nonpharmacologic therapies for acute or chronic nonradicular or radicular low back pain. DATA SOURCES: Ovid MEDLINE (January 2008 through February 2016), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and reference lists. STUDY SELECTION: Randomized trials of 9 nonpharmacologic options versus sham treatment, wait list, or usual care, or of 1 nonpharmacologic option versus another. DATA EXTRACTION: One investigator abstracted data, and a second checked abstractions for accuracy; 2 investigators independently assessed study quality. DATA SYNTHESIS: The number of trials evaluating nonpharmacologic therapies ranged from 2 (tai chi) to 121 (exercise). New evidence indicates that tai chi (strength of evidence [SOE], low) and mindfulness-based stress reduction (SOE, moderate) are effective for chronic low back pain and strengthens previous findings regarding the effectiveness of yoga (SOE, moderate). Evidence continues to support the effectiveness of exercise, psychological therapies, multidisciplinary rehabilitation, spinal manipulation, massage, and acupuncture for chronic low back pain (SOE, low to moderate). Limited evidence shows that acupuncture is modestly effective for acute low back pain (SOE, low). The magnitude of pain benefits was small to moderate and generally short term; effects on function generally were smaller than effects on pain. LIMITATION: Qualitatively synthesized new trials with prior meta-analyses, restricted to English-language studies; heterogeneity in treatment techniques; and inability to exclude placebo effects. CONCLUSION: Several nonpharmacologic therapies for primarily chronic low back pain are associated with small to moderate, usually short-term effects on pain; findings include new evidence on mind-body interventions. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. (PROSPERO: CRD42014014735).
背景:2007 年美国医师学院发布了针对腰痛的非药物治疗选择指南。目前有新的证据。
目的:系统评价非药物治疗急性或慢性非神经根性或神经根性腰痛的现有证据。
数据来源:Ovid MEDLINE(2008 年 1 月至 2016 年 2 月)、Cochrane 对照试验中心注册库、Cochrane 系统评价数据库和参考文献列表。
研究选择:9 种非药物治疗选择与假治疗、等待名单或常规护理,或 1 种非药物治疗选择与另 1 种治疗选择的随机试验。
数据提取:1 名调查员提取数据,另 1 名调查员检查数据准确性;2 名调查员独立评估研究质量。
数据综合:评估非药物治疗的试验数量从 2 项(太极)到 121 项(运动)不等。新证据表明,太极(证据强度[SOE],低)和基于正念的压力减轻(SOE,中)对慢性腰痛有效,并加强了之前关于瑜伽(SOE,中)有效性的发现。证据继续支持运动、心理疗法、多学科康复、脊柱推拿、按摩和针灸治疗慢性腰痛的有效性(SOE,低至中)。有限的证据表明,针灸对急性腰痛有一定疗效(SOE,低)。疼痛获益的幅度较小,通常为短期;对功能的影响通常小于对疼痛的影响。
局限性:定性综合新试验与先前的荟萃分析,仅限于英语研究;治疗技术的异质性;无法排除安慰剂效应。
结论:几种主要用于慢性腰痛的非药物治疗方法与小到中等、通常短期的疼痛效果相关;结果包括对身心干预的新证据。
主要资金来源:美国医疗保健研究与质量局。(PROSPERO:CRD42014014735)。
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