Burchert D
Diabetologische Schwerpunktpraxis, Römerstraße 14, 55129, Mainz, Deutschland.
Internist (Berl). 2021 Jan;62(1):24-33. doi: 10.1007/s00108-020-00920-y. Epub 2020 Dec 18.
A systematic survey of the symptoms of back pain in terms of the triggering event and onset, nature of the pain and the extent to which pain dynamics can be influenced (lying or standing, under stress, nocturnal pain, localized percussion tenderness, B symptoms, etc.), as well as a structured clinical examination (segment height, radiance, projection, reflex status, sensitivity, and motor function), allows an initial and therefore orienting classification of back pain as non-specific or specific. Thus, in the primary care setting, many patients can be treated extremely effectively and economically from a cost perspective. The more precise the initial findings are, the more effective the measures taken are in general. In addition to the fastest possible pain relief, it is important to prevent the disease taking an unfavorable course and to avoid chronicity. In addition to non-pharmacological measures (initial rest and starting home exercises early on, promoting everyday mobility, physiotherapy, manual therapy, etc.), a wide range of pharmacological treatment alternatives is available. In the further course of treatment, it may be necessary to consult medical specialists in the fields of radiology, orthopedics, neurology, neurosurgery, rheumatology, psychotherapy, and psychiatry, among others. Treatment is managed by the primary care provider, who should also receive and re-evaluate all findings during the course of the disease.
根据引发事件和发病情况、疼痛性质以及疼痛动态受影响的程度（躺卧或站立、压力状态下、夜间疼痛、局部叩击压痛、B症状等），对背痛症状进行系统调查，以及进行结构化临床检查（节段高度、放射、投影、反射状态、感觉和运动功能），可以对背痛进行初步的、因此也是定向的分类，分为非特异性或特异性背痛。因此，在初级保健环境中，从成本角度来看，许多患者可以得到极其有效且经济的治疗。初始检查结果越精确，总体上所采取的措施就越有效。除了尽可能快地缓解疼痛外，防止疾病发展为不利病程并避免慢性化也很重要。除了非药物措施（初期休息并尽早开始家庭锻炼、促进日常活动能力、物理治疗、手法治疗等）外，还有多种药物治疗选择。在治疗的后续过程中，可能需要咨询放射学、骨科、神经科、神经外科、风湿病学、心理治疗和精神病学等领域的医学专家。治疗由初级保健提供者管理，其在疾病过程中还应接收并重新评估所有检查结果。
