Peck Jacquelin, Urits Ivan, Peoples Sandy, Foster Lukas, Malla Akshara, Berger Amnon A, Cornett Elyse M, Kassem Hisham, Herman Jared, Kaye Alan D, Viswanath Omar
Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Pain Ther. 2021 Jun;10(1):69-80. doi: 10.1007/s40122-020-00209-w. Epub 2020 Nov 4.
Chronic low back pain (CLBP) is a major contributor to societal disease burden and years lived with disability. Nonspecific low back pain (LBP) is attributed to physical and psychosocial factors, including lifestyle factors, obesity, and depression. Mechanical low back pain occurs related to repeated trauma to or overuse of the spine, intervertebral disks, and surrounding tissues. This causes disc herniation, vertebral compression fractures, lumbar spondylosis, spondylolisthesis, and lumbosacral muscle strain.
A systematic review of relevant literature was conducted. CENTRAL, MEDLINE, EMBASE, PubMed, and two clinical trials registry databases up to 24 June 2015 were included in this review. Search terms included: low back pain, over the counter, non-steroidal anti-inflammatory (NSAID), CLBP, ibuprofen, naproxen, acetaminophen, disk herniation, lumbar spondylosis, vertebral compression fractures, spondylolisthesis, and lumbosacral muscle strain. Over-the-counter analgesics are the most frequently used first-line medication for LBP, and current guidelines indicate that over-the-counter medications should be the first prescribed treatment for non-specific LBP. Current literature suggests that NSAIDs and acetaminophen as well as antidepressants, muscle relaxants, and opioids are effective treatments for CLBP. Recent randomized controlled trials also evaluate the benefit of buprenorphine, tramadol, and strong opioids such as oxycodone. This systematic review discusses current evidence pertaining to non-prescription treatment options for chronic low back pain.
慢性下腰痛（CLBP）是社会疾病负担和残疾生活年限的主要促成因素。非特异性下腰痛（LBP）归因于身体和心理社会因素，包括生活方式因素、肥胖和抑郁。机械性下腰痛的发生与脊柱、椎间盘及周围组织的反复创伤或过度使用有关。这会导致椎间盘突出、椎体压缩性骨折、腰椎退变、腰椎滑脱和腰骶部肌肉劳损。
对相关文献进行了系统综述。本综述纳入了截至2015年6月24日的CENTRAL、MEDLINE、EMBASE、PubMed以及两个临床试验注册数据库。检索词包括：下腰痛、非处方、非甾体抗炎药（NSAID）、CLBP、布洛芬、萘普生、对乙酰氨基酚、椎间盘突出、腰椎退变、椎体压缩性骨折、腰椎滑脱和腰骶部肌肉劳损。非处方镇痛药是LBP最常用的一线药物，当前指南表明非处方药物应作为非特异性LBP的首选处方治疗。当前文献表明，NSAIDs、对乙酰氨基酚以及抗抑郁药、肌肉松弛剂和阿片类药物是CLBP的有效治疗方法。近期的随机对照试验还评估了丁丙诺啡、曲马多和羟考酮等强效阿片类药物的益处。本系统综述讨论了有关慢性下腰痛非处方治疗选择的当前证据。
