Croft P, Raspe H
University of Keele School of Postgraduate Medicine, Industrial and Community Health Research Centre, Hartshill, Stoke-on-Trent, UK.
Baillieres Clin Rheumatol. 1995 Aug;9(3):565-83. doi: 10.1016/s0950-3579(05)80259-6.
Classification of back pain is a difficult task. Traditional schemes have focused on the small percentage of cases which have specific causes. Structural anomalies observed on X-ray examination explain only a small proportion of back pain cases, and the emphasis placed on these in the traditional schemes is, as Anderson put it, the tail wagging the dog (Anderson, 1977). Many syndrome classifications are based on arbitrary notions of cause, with little empirical justification and no evidence that they can reliably and usefully be applied in practice. More pragmatic approaches start with the separation of the serious from the less serious, and the distinction between spinal pain and pain arising from outside the spine. The classification of the large majority of back pain cases which are 'non-specific' is best approached by grading the severity of the clinical and psychological features of back pain and their disabling consequences. Such grading schemes also provide the most appropriate outcome measures for clinical and epidemiological back pain research.
背痛的分类是一项艰巨的任务。传统的分类方法集中在少数有特定病因的病例上。X线检查发现的结构异常仅能解释一小部分背痛病例，正如安德森所说，传统分类方法中对这些异常的强调是本末倒置（安德森，1977年）。许多综合征分类是基于随意的病因概念，几乎没有实证依据，也没有证据表明它们能在实践中可靠且有效地应用。更务实的方法是首先区分病情的严重程度，以及区分脊柱疼痛和脊柱外疼痛。对于大多数“非特异性”背痛病例，最好通过对背痛的临床和心理特征及其致残后果的严重程度进行分级来进行分类。这种分级方案也为临床和流行病学背痛研究提供了最合适的结果指标。
