Jerjir Ali, Nietvelt Frederik, Smet Iris, D'hondt Nina, Van Buyten Jean-Pierre
Multidisciplinary Pain Clinic, VITAZ Hospitals, 9100 Sint-Niklaas, Belgium.
Life (Basel). 2025 Apr 23;15(5):690. doi: 10.3390/life15050690.
Chronic low back pain (CLBP) significantly impacts individuals' quality of life and functional abilities. In non-oncological settings, CLBP is often treated for long periods using pharmacotherapy. This paper provides a comprehensive overview of pharmacological treatments for CLBP, detailing their mechanisms of action, adverse effects, and evidence supporting their use. We discuss various medication classes, including NSAIDs, acetaminophen, antidepressants, gabapentinoids, tramadol, major opioids, corticosteroids, antispasticity drugs, benzodiazepines, and antibiotics. Special emphasis is given to the opioid crisis, examining its history, the pathophysiology of opioid tolerance and dependence, the need for cautious opioid use, the key challenges in treatment and emerging medications for CLBP. We also share insights from our experiences with polypharmacy, commonly seen in CLBP patients, at a specialized pain centre in Belgium.
慢性下腰痛（CLBP）对个人的生活质量和功能能力有重大影响。在非肿瘤学环境中，CLBP通常长期使用药物治疗。本文全面概述了CLBP的药物治疗方法，详细介绍了它们的作用机制、不良反应以及支持其使用的证据。我们讨论了各种药物类别，包括非甾体抗炎药、对乙酰氨基酚、抗抑郁药、加巴喷丁类药物、曲马多、主要阿片类药物、皮质类固醇、抗痉挛药物、苯二氮䓬类药物和抗生素。特别强调了阿片类药物危机，审视其历史、阿片类药物耐受性和依赖性的病理生理学、谨慎使用阿片类药物的必要性、治疗中的关键挑战以及CLBP的新兴药物。我们还分享了在比利时一家专业疼痛中心对CLBP患者常见的联合用药情况的经验见解。
