Parr Adam, Askin Geoffrey
MBBS, FRACS (Ortho), Clinical Researcher, Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation, QUT, Qld; Adult and Paediatric Spine Surgeon, Queensland Children@s Hospital, Princess Alexandra Hospital, Greenslopes Private Hospital and The Wesley Hospital, Qld.
MBBS, FRACS (Ortho), Clinical Research Director, Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation, QUT, Qld; Adult and Paediatric Spine Surgeon, Queensland Children's Hospital and The Mater Hospital, Qld.
Aust J Gen Pract. 2020 Nov;49(11):724-727. doi: 10.31128/AJGP-06-20-5476.
Low back pain (LBP) is a common presentation in general practice. Clinical workup must exclude sinister underlying diseases. Treatment of central LBP is difficult given the numerous treatment options available.
The aim of this article is to help clinicians assess patients with LBP and formulate evidence-based treatment decisions.
Patient presentations can be stratified according to the presence of red flags and pain type (ie non-spinal, radicular, non‑organic and central). The vast majority of patients with acute central back pain experience improvement of their symptoms. Treatment options include education, lifestyle modification, heat, massage, graduated return to early activity, nonsteroidal anti-inflammatory medications and muscle relaxants when appropriate. Chronic LBP treatment can also include paracetamol and physiotherapy. Second-line treatment can include psychological therapy, multidisciplinary rehabilitation, targeted injections and antidepressants. Tapentadol is a safe and effective medication for treating severe LBP. Pain specialist referral should be considered if patients require controlled analgesia. Surgical treatment has narrow indications in central non-radicular back pain and is considered as a last-line treatment in selected patients.
下腰痛（LBP）是全科医疗中常见的症状。临床检查必须排除潜在的严重疾病。鉴于有众多可用的治疗选择，中枢性下腰痛的治疗具有挑战性。
本文旨在帮助临床医生评估下腰痛患者并制定基于证据的治疗决策。
患者的表现可根据是否存在警示信号和疼痛类型（即非脊柱性、根性、非器质性和中枢性）进行分层。绝大多数急性中枢性背痛患者的症状会有所改善。治疗选择包括教育、生活方式改变、热敷、按摩、逐步恢复早期活动，必要时使用非甾体类抗炎药和肌肉松弛剂。慢性下腰痛的治疗还可包括对乙酰氨基酚和物理治疗。二线治疗可包括心理治疗、多学科康复、靶向注射和抗抑郁药。曲马多是治疗严重下腰痛的一种安全有效的药物。如果患者需要控制镇痛，应考虑转诊至疼痛专科医生。手术治疗在中枢性非根性背痛中的适应证较窄，被视为特定患者的最后一线治疗方法。
