Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil.
Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Eur Spine J. 2018 Nov;27(11):2791-2803. doi: 10.1007/s00586-018-5673-2. Epub 2018 Jul 3.
OBJECTIVE: The aim of this study was to provide an overview of the recommendations regarding the diagnosis and treatment contained in current clinical practice guidelines for patients with non-specific low back pain in primary care. We also aimed to examine how recommendations have changed since our last overview in 2010. METHOD: The searches for clinical practice guidelines were performed for the period from 2008 to 2017 in electronic databases. Guidelines including information regarding either the diagnosis or treatment of non-specific low back pain, and targeted at a multidisciplinary audience in the primary care setting, were considered eligible. We extracted data regarding recommendations for diagnosis and treatment, and methods for development of guidelines. RESULTS: We identified 15 clinical practice guidelines for the management of low back pain in primary care. For diagnosis of patients with non-specific low back pain, the clinical practice guidelines recommend history taking and physical examination to identify red flags, neurological testing to identify radicular syndrome, use of imaging if serious pathology is suspected (but discourage routine use), and assessment of psychosocial factors. For treatment of patients with acute low back pain, the guidelines recommend reassurance on the favourable prognosis and advice on returning to normal activities, avoiding bed rest, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and weak opioids for short periods. For treatment of patients with chronic low back pain, the guidelines recommend the use of NSAIDs and antidepressants, exercise therapy, and psychosocial interventions. In addition, referral to a specialist is recommended in case of suspicion of specific pathologies or radiculopathy or if there is no improvement after 4 weeks. While there were a few discrepancies across the current clinical practice guidelines, a substantial proportion of recommendations was consistently endorsed. In the current review, we identified some differences compared to the previous overview regarding the recommendations for assessment of psychosocial factors, the use of some medications (e.g., paracetamol) as well as an increasing amount of information regarding the types of exercise, mode of delivery, acupuncture, herbal medicines, and invasive treatments. These slides can be retrieved under Electronic Supplementary Material.
目的:本研究旨在概述当前初级保健中非特异性下腰痛患者的诊断和治疗临床实践指南中的推荐意见。我们还旨在检查自 2010 年上次综述以来,推荐意见发生了哪些变化。
方法:我们在电子数据库中对 2008 年至 2017 年期间的临床实践指南进行了搜索。符合条件的指南包括非特异性下腰痛的诊断或治疗信息,且针对初级保健中的多学科受众。我们提取了关于诊断和治疗建议以及指南制定方法的数据。
结果:我们确定了 15 项初级保健中管理下腰痛的临床实践指南。对于非特异性下腰痛患者的诊断,临床实践指南建议进行病史采集和体格检查以识别危险信号,进行神经学检查以识别根性综合征,如果怀疑有严重的病理情况则使用影像学检查(但不鼓励常规使用),并评估心理社会因素。对于急性下腰痛患者的治疗,指南建议对有利的预后进行保证,并建议恢复正常活动,避免卧床休息,短期使用非甾体抗炎药(NSAIDs)和弱阿片类药物。对于慢性下腰痛患者的治疗,指南建议使用 NSAIDs 和抗抑郁药、运动疗法和心理社会干预。此外,如果怀疑有特定的病理或根性病变,或者在 4 周后没有改善,建议转诊给专家。尽管当前的临床实践指南之间存在一些差异,但相当一部分建议得到了一致认可。在本次综述中,我们发现与之前的综述相比,在评估心理社会因素、某些药物的使用(如对乙酰氨基酚)以及关于运动类型、提供方式、针灸、草药和侵入性治疗的信息方面存在一些差异。这些幻灯片可以在电子补充材料中检索到。
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