George Steven Z, Goode Adam P
Department of Orthopaedic Surgery, Duke Clinical Research Institute Duke University, Durham, NC, United States.
Pain Rep. 2020 Sep 24;5(5):e827. doi: 10.1097/PR9.0000000000000827. eCollection 2020 Sep-Oct.
Musculoskeletal (MSK) pain conditions are highly prevalent and a leading cause of disability globally. When people with MSK pain seek health care, they often receive treatment not aligned with best practices, including initial management options such as opioids. In recent practice guidelines, nonpharmacological treatments have been emphasized for initial pain management, and physical therapists are providers who routinely deliver nonpharmacological treatments. The purpose of this review is to describe the current and future state for how physical therapy may be used to increase exposure to nonpharmacological treatments for MSK pain conditions. For the current state, we review existing observational evidence investigating early exposure to physical therapy and its influence on subsequent opioid use. For the future state, we propose clinical research questions that could define the role of physical therapy on interdisciplinary teams working towards improving effectiveness of nonpharmacological treatments through more rigorous study designs. These clinical questions are intended to guide health services research and clinical trials when building an evidence base of nonpharmacological care options for MSK pain conditions.
肌肉骨骼（MSK）疼痛病症在全球范围内高度流行，是导致残疾的主要原因。当患有MSK疼痛的人寻求医疗保健时，他们通常接受的治疗与最佳实践不一致，包括使用阿片类药物等初始管理选项。在最近的实践指南中，非药物治疗已被强调用于初始疼痛管理，而物理治疗师是常规提供非药物治疗的医疗服务提供者。本综述的目的是描述物理治疗如何用于增加MSK疼痛病症非药物治疗的当前和未来状况。对于当前状况，我们回顾了现有的观察性证据，调查早期接受物理治疗及其对后续阿片类药物使用的影响。对于未来状况，我们提出了一些临床研究问题，这些问题可以通过更严格的研究设计来界定物理治疗在跨学科团队中所起的作用，这些团队致力于提高非药物治疗的有效性。这些临床问题旨在为构建MSK疼痛病症非药物护理选项的证据基础时的卫生服务研究和临床试验提供指导。
