Nicol Vanina, Verdaguer Claire, Daste Camille, Bisseriex Hélène, Lapeyre Éric, Lefèvre-Colau Marie-Martine, Rannou François, Rören Alexandra, Facione Julia, Nguyen Christelle
Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, AP-HP, Centre-Université de Paris, 75014 Paris, France.
Service de Médecine Physique et de Réadaptation, Hôpital d'Instruction des Armées Percy, 92140 Clamart, France.
J Clin Med. 2023 Feb 20;12(4):1685. doi: 10.3390/jcm12041685.
Chronic low back pain (cLBP) is a public and occupational health problem that is a major professional, economic and social burden. We aimed to provide a critical overview of current international recommendations regarding the management of non-specific cLBP. We conducted a narrative review of international guidelines for the diagnosis and conservative treatment of people with non-specific cLBP. Our literature search yielded five reviews of guidelines published between 2018 and 2021. In these five reviews, we identified eight international guidelines that fulfilled our selection criteria. We added the 2021 French guidelines into our analysis. Regarding diagnosis, most international guidelines recommend searching for so-called yellow, blue and black flags, in order to stratify the risk of chronicity and/or persistent disability. The relevance of clinical examination and imaging are under debate. Regarding management, most international guidelines recommend non-pharmacological treatments, including exercise therapy, physical activity, physiotherapy and education; however, multidisciplinary rehabilitation, in selected cases, is the core treatment recommended for people with non-specific cLBP. Oral, topical or injected pharmacological treatments are under debate, and may be offered to selected and well-phenotyped patients. The diagnosis of people with cLBP may lack precision. All guidelines recommend multimodal management. In clinical practice, the management of individuals with non-specific cLBP should combine non-pharmacological and pharmacological treatments. Future research should focus on improving tailorization.
慢性下腰痛(cLBP)是一个公共卫生和职业健康问题,是一项重大的职业、经济和社会负担。我们旨在对当前关于非特异性cLBP管理的国际建议进行批判性综述。我们对非特异性cLBP患者诊断和保守治疗的国际指南进行了叙述性综述。我们的文献检索得到了2018年至2021年间发表的五篇指南综述。在这五篇综述中,我们确定了八项符合我们选择标准的国际指南。我们将2021年法国指南纳入了分析。关于诊断,大多数国际指南建议寻找所谓的黄色、蓝色和黑色警示标志,以便对慢性化和/或持续性残疾风险进行分层。临床检查和影像学检查的相关性存在争议。关于管理,大多数国际指南推荐非药物治疗,包括运动疗法、体育活动、物理治疗和教育;然而,在某些情况下,多学科康复是推荐给非特异性cLBP患者的核心治疗方法。口服、局部或注射药物治疗存在争议,可能会提供给经过选择且表型明确的患者。cLBP患者的诊断可能缺乏精确性。所有指南都推荐多模式管理。在临床实践中,非特异性cLBP患者的管理应结合非药物和药物治疗。未来的研究应专注于改善个性化治疗。
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