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成人非低背、肌肉骨骼损伤所致急性疼痛的非药物与药物治疗:美国医师学院和美国家庭医师学会临床指南。

Nonpharmacologic and Pharmacologic Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries in Adults: A Clinical Guideline From the American College of Physicians and American Academy of Family Physicians.

机构信息

American College of Physicians, Philadelphia, Pennsylvania (A.Q.).

Yale School of Medicine, New Haven, Connecticut (R.M.M.).

出版信息

Ann Intern Med. 2020 Nov 3;173(9):739-748. doi: 10.7326/M19-3602. Epub 2020 Aug 18.


DOI:10.7326/M19-3602
PMID:32805126
Abstract

DESCRIPTION: The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) developed this guideline to provide clinical recommendations on nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults in the outpatient setting. The guidance is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences. This guideline does not address noninvasive treatment of low back pain, which is covered by a separate ACP guideline that has also been endorsed by AAFP. METHODS: This guideline is based on a systematic evidence review on the comparative efficacy and safety of nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults in the outpatient setting and a systematic review on the predictors of prolonged opioid use. We evaluated the following clinical outcomes using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system: pain (at ≤2 hours and at 1 to 7 days), physical function, symptom relief, treatment satisfaction, and adverse events. TARGET AUDIENCE AND PATIENT POPULATION: The target audience is all clinicians, and the target patient population is adults with acute pain from non-low back, musculoskeletal injuries. RECOMMENDATION 1: RECOMMENDATION 2A: RECOMMENDATION 2B: RECOMMENDATION 3:

摘要

描述:美国医师学院(ACP)和美国家庭医师学会(AAFP)制定了本指南,为成人门诊中非低背部、肌肉骨骼损伤引起的急性疼痛的非药物和药物治疗提供临床建议。该指南基于当前关于益处和危害的最佳可用证据,考虑到成本和患者的价值观和偏好。本指南不涉及非侵入性治疗腰痛,这由 ACP 另一份已得到 AAFP 认可的指南涵盖。 方法:本指南基于系统的证据审查,评估了成人门诊中非低背部、肌肉骨骼损伤引起的急性疼痛的非药物和药物治疗的比较疗效和安全性,以及预测阿片类药物长期使用的系统评价。我们使用 GRADE(推荐评估、制定和评估)系统评估了以下临床结局:疼痛(≤2 小时和 1 至 7 天)、身体功能、症状缓解、治疗满意度和不良事件。 目标受众和患者人群:目标受众是所有临床医生,目标患者人群是患有非低背部、肌肉骨骼损伤引起的急性疼痛的成年人。 建议 1: 建议 2A: 建议 2B: 建议 3:

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