Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA.
J Altern Complement Med. 2020 May;26(5):369-375. doi: 10.1089/acm.2019.0448. Epub 2020 Mar 11.
To measure the use of complementary health approaches (CHAs) recommended in recent clinical practice guidelines relating to low-back pain, multivariate factors associated with their use, and clinical outcomes of CHA users and nonusers. Observational cross-sectional study. The Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation. A total of 568 patients with chronic low-back pain. Massage therapy, spinal manipulation, yoga, and acupuncture. The numerical rating scale for low-back pain intensity, Roland-Morris Disability Questionnaire for back-related disability, and the Patient-Reported Outcomes Measurement Information System with 29 items for quality-of-life deficits relating to sleep disturbance, pain interference with activities, anxiety, depression, and low energy/fatigue. The distribution of the number of different CHAs used by patients for low-back pain was as follows: 0, 179 (31.5%); 1, 139 (24.5%); 2, 160 (28.2%); 3, 70 (12.3%); and 4, 20 (3.5%). The numbers of patients using the specific CHAs were as follows: massage therapy, 271 (47.7%); spinal manipulation, 238 (41.9%); yoga, 144 (25.4%); and acupuncture, 96 (16.9%). Opioids had been used for low-back pain by 415 (73.1%) patients. Higher levels of education and higher pain self-efficacy scores were associated with greater use of any CHA, whereas increasing age and being Black were associated with lesser use of any CHA. Any CHA use was associated with lesser low-back pain intensity and lesser back-related disability. Patients who used massage therapy reported better clinical outcomes across all three dimensions. Patient pain self-efficacy also enhanced the effect of CHA use. The use of CHAs relative to opioids for low-back pain was inconsistent with recommendations from recent clinical practice guidelines despite clinical benefits with CHA use in this study. More research is needed on ways to improve the uptake of CHAs recommended for low-back pain, particularly among older and Black patients.
为了衡量与慢性下背痛相关的最新临床实践指南中推荐的补充治疗方法（CAM）的使用情况、与使用相关的多种因素以及 CAM 使用者和非使用者的临床结局。观察性横截面研究。疼痛登记处用于流行病学、临床和干预研究及创新。共纳入 568 例慢性下背痛患者。按摩疗法、脊柱推拿、瑜伽和针灸。下背痛强度的数字评分量表、与背部相关的残疾 Roland-Morris 残疾问卷以及包含 29 项与睡眠障碍、活动疼痛干扰、焦虑、抑郁和低能量/疲劳相关的生活质量缺陷的患者报告的结果测量信息系统。患者用于治疗下背痛的不同 CAM 数量分布如下：0，179（31.5％）；1，139（24.5％）；2，160（28.2％）；3，70（12.3％）；4，20（3.5％）。使用特定 CAM 的患者数量如下：按摩疗法，271（47.7％）；脊柱推拿，238（41.9％）；瑜伽，144（25.4％）；针灸，96（16.9％）。415（73.1％）例患者因下背痛而使用阿片类药物。较高的教育水平和较高的疼痛自我效能评分与更广泛地使用任何 CAM 相关，而年龄增长和为黑人与较少使用任何 CAM 相关。任何 CAM 的使用均与下背痛强度较低和与背部相关的残疾程度较低相关。使用按摩疗法的患者在所有三个维度上的临床结局均更好。患者的疼痛自我效能也增强了 CAM 使用的效果。尽管本研究中使用 CAM 具有临床益处，但相对于阿片类药物，下背痛患者使用 CAM 的情况与最近的临床实践指南的建议不一致。需要进一步研究如何提高对推荐用于治疗下背痛的 CAM 的采用率，特别是在老年和黑人患者中。
