Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
Wien Klin Wochenschr. 2019 Nov;131(21-22):541-549. doi: 10.1007/s00508-019-01542-7. Epub 2019 Sep 6.
Low back pain (LBP) is a widely prevalent chronic pain disorder associated with a high burden on individuals and society. In the subjective perception of patients with LBP, probably the most important health outcomes associated with LBP are those that effect everyday performance. Such outcomes include reduction in activities of daily living (ADL), in work ability (WA), and in sexual function. This narrative review aimed to (1) examine the association between LBP and the three mentioned outcomes of everyday performance, (2) to explain possible mediating factors promoting these associations, and (3) to discuss possible implications for treatment and rehabilitation. Studies have shown that LBP can generate anxiety of movement leading to movement avoidance (fear-avoidance beliefs), which may lead to deconditioning and further increasing problems with ADL, WA and decreasing sexual function. Furthermore, common mental disorders, such as depression, anxiety, and stress-related disorders, which also often co-occur with LBP can lead to adverse effects on everyday performance and vice versa, can be the consequence of such problems and aggravate LBP. Although there is no universally accepted treatment modality that fits every patient with LBP, physical training, comprehensive patient education, and workplace or home modifications have been shown to be able to interrupt the mutual influence between LBP and the described mediating factors, and have a beneficial effect on ADL, WA, and sexual function. For this, a multidisciplinary approach is necessary which includes multiprofessional care teams, participation of the patients, and involvement of different settings, such as workplace, home, and physical training facilities.
下背痛（LBP）是一种广泛流行的慢性疼痛障碍，给个人和社会带来了沉重负担。在 LBP 患者的主观感知中，与 LBP 相关的最重要的健康结果可能是那些影响日常活动的结果。这些结果包括日常生活活动（ADL）、工作能力（WA）和性功能的减少。本叙述性综述旨在：（1）研究 LBP 与上述三种日常活动表现结果之间的关系；（2）解释促进这些关系的可能中介因素；（3）讨论对治疗和康复的可能影响。研究表明，LBP 会引起运动焦虑，导致运动回避（恐惧回避信念），从而导致功能失调和进一步增加 ADL、WA 问题，并降低性功能。此外，常见的精神障碍，如抑郁症、焦虑症和与压力相关的障碍，也常与 LBP 同时发生，这些障碍会对日常活动表现产生不利影响，反之亦然，也可能是这些问题的后果，并加重 LBP。虽然没有一种普遍接受的治疗方式适合每个 LBP 患者，但身体训练、综合患者教育以及工作场所或家庭改造已被证明能够中断 LBP 与描述的中介因素之间的相互影响，并对 ADL、WA 和性功能产生有益影响。为此，需要采取多学科方法，包括多专业护理团队、患者参与以及不同环境的参与，如工作场所、家庭和体育训练设施。
