Custers Paulien, Van de Kelft Erik, Eeckhaut Bart, Sabbe Wouter, Hofman An, Debuysscher Annick, Van Acker Gilles, Maes Gaethan
Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
Department of Physical Medicine and Rehabilitation, VITAZ, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium.
Life (Basel). 2024 Aug 29;14(9):1090. doi: 10.3390/life14091090.
Chronic low back pain is one of the most frequent reasons for medical consultation. It is important to make the correct diagnosis to select the most appropriate treatment in a stepwise approach. In this narrative review, we focus on the clinical examination, the diagnosis, and the conservative treatment of chronic non-specific low back pain. Belgian guidelines for low back pain were used as a basis, followed by a snowball search starting from two articles. Besides that, the Cochrane database was consulted using the following research areas: "multidisciplinary biopsychosocial rehabilitation", "physical examination of lumbar spine", and "rehabilitation back pain". Lastly, we took information from three handbooks. The diagnosis of low back pain starts with a thorough history, including red, yellow, orange, black, and blue flags. Physical, neurological, sensory, and motor testing is performed and complemented with specific tests for low back pain. With a focus on the conservative treatment, pharmacological and non-pharmacological treatments are possible. For CNSLBP, conservative management is advised, starting with reassurance and clear patient education about the condition. While additional treatments, such as manipulation, massage, and acupuncture, can be considered, their effectiveness is not well supported by evidence. Our center emphasizes exercise within a multidisciplinary biopsychosocial rehabilitation program, and although evidence for this approach is limited, we have seen positive outcomes, including improved mobility, strength, and higher return-to-work rates, particularly with the David Spine Concept (DSC).
慢性下腰痛是最常见的就医原因之一。采用循序渐进的方法做出正确诊断以选择最合适的治疗方法很重要。在这篇叙述性综述中，我们重点关注慢性非特异性下腰痛的临床检查、诊断和保守治疗。以比利时腰痛指南为基础，从两篇文章开始进行滚雪球式检索。除此之外，还使用以下研究领域在考克兰数据库进行了查询：“多学科生物心理社会康复”、“腰椎体格检查”和“腰痛康复”。最后，我们从三本手册中获取了信息。下腰痛的诊断始于全面的病史询问，包括红色、黄色、橙色、黑色和蓝色警示信号。进行体格、神经、感觉和运动测试，并辅以针对下腰痛的特定测试。在保守治疗方面，可以采用药物和非药物治疗。对于慢性非特异性下腰痛，建议采用保守管理，首先要让患者放心，并对病情进行清晰的患者教育。虽然可以考虑其他治疗方法，如手法治疗、按摩和针灸，但其有效性缺乏充分证据支持。我们中心强调在多学科生物心理社会康复计划中进行运动锻炼，尽管这种方法的证据有限，但我们已经看到了积极的效果，包括改善活动能力、增强力量以及提高重返工作岗位的比例，尤其是采用大卫脊柱概念（DSC）时。
