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坐骨神经痛。家庭医生的管理方法。

Sciatica. Management for family physicians.

作者信息

Aguilar-Shea Antonio L, Gallardo-Mayo Cristina, Sanz-González Rosa, Paredes Igor

机构信息

Family Physician, Centro de Salud Puerta de Madrid, Atención Primaria de Madrid, Spain.

Anesthesiology and Reanimation, Universitary Hospital Infanta Leonor, Madrid, Spain.

出版信息

J Family Med Prim Care. 2022 Aug;11(8):4174-4179. doi: 10.4103/jfmpc.jfmpc_1061_21. Epub 2022 Aug 30.

Abstract

Sciatica or lower back pain with sciatic radiation is a frequent medical problem in primary care. The aim of this article is to better inform medical practitioners on diagnosis and management of lower back pain with sciatic radiation. Updated information on sciatica management is important for family physicians. Here, we review the available literature on sciatica. Relevant articles were identified via a literature search in PubMed by focusing on the following key points: diagnostic and definition criteria, red flags, and therapy. In addition, the authors' clinical experience has been utilised to propose a schema to assist in the assessment and treatment of sciatica in a primary care setting. Sciatica diagnosis is based on a careful history and clinical examination. Imaging is usually not necessary at first; testing with X-ray and MRI are key to diagnosing lumbar instability and herniated discs. Management includes physical conditioning, proper pain management, and surgery as a last resort. Pain treatment includes analgesics, anticonvulsants and muscle relaxants. A more aggressive approach would include epidural infiltrations and radiofrequency.

摘要

坐骨神经痛或伴有坐骨神经放射痛的下背痛是基层医疗中常见的医学问题。本文旨在让医生更好地了解伴有坐骨神经放射痛的下背痛的诊断和管理。关于坐骨神经痛管理的最新信息对家庭医生很重要。在此,我们回顾了有关坐骨神经痛的现有文献。通过在PubMed中进行文献检索,重点关注以下关键点来确定相关文章:诊断和定义标准、警示信号及治疗方法。此外,作者利用临床经验提出了一个方案,以协助在基层医疗环境中评估和治疗坐骨神经痛。坐骨神经痛的诊断基于详细的病史和临床检查。起初通常无需进行影像学检查;X线和磁共振成像(MRI)检查是诊断腰椎不稳和椎间盘突出的关键。管理措施包括身体调理、适当的疼痛管理,手术是最后的手段。疼痛治疗包括使用镇痛药、抗惊厥药和肌肉松弛剂。更积极的方法包括硬膜外注射和射频治疗。

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