Orrillo Enrique, Vidal Neira Luis, Piedimonte Fabián, Plancarte Sanchez Ricardo, Astudilllo Mihovilovic Smiljan, Narvaez Tamayo Marco Antonio, Rekatsina Martina, Varrassi Giustino
Pain Medicine, Asociacion Peruana para el Estudio del Dolor, Lima, PER.
Rheumatology, Centro de Diagnóstico de Osteoporosis y Enfermedades Reumáticas (CEDOR), Lima, PER.
Cureus. 2022 Mar 9;14(3):e22992. doi: 10.7759/cureus.22992. eCollection 2022 Mar.
Low back pain (LBP) is a prevalent condition associated with disability. Treating patients with LBP becomes further complicated by the potential presence of underlying conditions, such as cancer or traumatic injury, or biopsychosocial aspects. LBP usually has a neuropathic component that must be assessed and treated appropriately. Pharmacological management of LBP requires a thorough knowledge of the available agents and the mechanisms of the LBP. Although there are effective pharmacological treatments for LBP, it is important to consider safety issues. Fixed-dose combination products may be helpful, as they can reduce opioid consumption without sacrificing analgesic benefits. Neuromodulation is an important and sometimes overlooked treatment option for LBP and may be appropriate for chronic LBP requiring long-term treatment. Imaging studies support neuroplastic changes in the brain as a result of neuromodulation. Interventional approaches to chronic LBP are numerous and must be appropriately selected based on the individual patient. Evidence in support of epidural injections for LBP is strong for short-term pain control but moderate to limited for long-term relief. Rehabilitation for LBP can be an important element of long-term care, and new forms of rehabilitation programs are being developed using telemedicine. A variety of new and established treatments are available for patients with LBP, and clinicians and patients may benefit from emerging new treatment modalities.
腰痛（LBP）是一种与残疾相关的常见病症。潜在的基础疾病（如癌症或创伤性损伤）或生物心理社会因素的存在，使得腰痛患者的治疗变得更加复杂。腰痛通常具有神经病理性成分，必须进行适当评估和治疗。腰痛的药物治疗需要全面了解可用药物以及腰痛的发病机制。虽然有有效的腰痛药物治疗方法，但考虑安全性问题很重要。固定剂量复方制剂可能会有所帮助，因为它们可以在不牺牲镇痛效果的情况下减少阿片类药物的使用。神经调节是腰痛的一种重要且有时被忽视的治疗选择，可能适用于需要长期治疗的慢性腰痛。影像学研究支持神经调节导致大脑神经可塑性变化。慢性腰痛的介入治疗方法众多，必须根据个体患者情况进行适当选择。硬膜外注射治疗腰痛在短期疼痛控制方面的证据确凿，但在长期缓解方面证据中等至有限。腰痛康复可以是长期护理的重要组成部分，并且正在利用远程医疗开发新形式的康复计划。对于腰痛患者有多种新的和已有的治疗方法，临床医生和患者可能会从新兴的新治疗模式中受益。
