Chang W D, Wang Y S, Chou C S, Chen W J, Huang Y S, Liaw S Y
Department of Family Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1994 Jun;53(6):338-45.
Back pain is one of the most common problems encountered in primary care clinics and causes great loss of work time, economy and expenditure of medical care. Knowledge of the cause of low back pain and effective treatment are rudimentary. We studied the functional approach to treatment of back pain of two acute (M:F = 1:1) and thirty chronic (M:F = 12:18) patients with back pain seen at a rural primary care clinic in September and October 1992.
Patients were included after completing an agreement form regarding the treatment plan (emphasizing therapeutic exercise, health education and as little medication as possible) in the first interview. A primary care physician specialised in family medicine personally gave treatment to the patients with free attendance to the clinic. A functional approach was adopted in four categories-therapeutic exercise, static and dynamic body biomechanics, awareness of proprioception, and maintenance of relaxed and balanced muscle tone. The patients were encouraged to perform daily activities rather than rest.
Two patients with acute back pain gained complete relief without medication, modalities, equipment or other treatment one and two weeks after the first visit, respectively. Among the 30 chronic patients, after eight weeks of treatment, 12/30 (40%) gained complete relief from pain, 4/30 (13.3%) obtained more than 3/4 and less than complete relief, 7/30 (23.3%) had more than 1/2 and less than 3/4 relief, 2/30 (6.7%) gained less than 1/2 pain relief, 1/30 (3.3%) had no improvement, 1/30 (3.3%) deteriorated, and 3/30 (10%) were lost during surveillance. The patients reported no loss of work time attributed to back pain. Two acute patients visited the clinic four times and three times, respectively. The former received three prescriptions for an upper respiratory infection one month after complete remission of back pain, and the latter received no prescriptions for medication. On average, each chronic patient visited the clinic 4.83 times in 8 weeks. In only 25 of 145 (17.2%) visits was medication prescribed for other indications, and in 8 of 145 (5.5%) visits vitamin B complex or Alinamin-F for placebo was prescribed. We used neither modalities nor equipment. Only 7/30 (23.3%) patients received concurrent treatment from other medical institutions. Regarding compliance with the programmed exercise at home, two acute patients complied well. Among the 30 chronic patients, 22 (73.3%) had good compliance, 3 (10%) had poor compliance, 2 (6.7%) failed to comply and 3 (10%) were lost in follow up.
Treating patients with back pain in primary care clinics with a functional approach by physicians appropriately trained in primary care was a good, efficacious, economic, and practical way, although neglected elsewhere. Further research and practice in our society might be worth while.
背痛是基层医疗诊所中最常见的问题之一，会导致大量工作时间损失、经济损失以及医疗费用支出。对腰痛病因及有效治疗方法的了解尚不完善。我们于1992年9月和10月在一家农村基层医疗诊所研究了针对两名急性背痛患者（男:女 = 1:1）和三十名慢性背痛患者（男:女 = 12:18）的功能性治疗方法。
在首次访谈中，患者签署关于治疗方案（强调治疗性锻炼、健康教育并尽量减少用药）的同意书后被纳入研究。一名专门从事家庭医学的基层医疗医生亲自为患者提供治疗，患者可免费就诊。治疗采用功能性方法，分为四类：治疗性锻炼、静态和动态身体生物力学、本体感觉意识以及保持放松和平衡的肌肉张力。鼓励患者进行日常活动而非休息。
两名急性背痛患者分别在首次就诊后1周和2周未使用药物、理疗、设备或其他治疗而完全缓解。在30名慢性患者中，经过8周治疗，12/30（40%）完全缓解疼痛，4/30（13.3%）疼痛缓解超过3/4但未完全缓解，7/30（23.3%）疼痛缓解超过1/2但少于3/4，2/30（6.7%）疼痛缓解少于1/2，1/30（3.3%）无改善，1/30（3.3%）病情恶化，3/30（10%）在随访期间失访。患者报告无因背痛导致的工作时间损失。两名急性患者分别就诊4次和3次。前者在背痛完全缓解1个月后因上呼吸道感染收到3张处方，后者未收到药物处方。平均而言，每名慢性患者在8周内就诊4.83次。在145次就诊中，仅25次（17.2%）因其他指征开具了药物处方，145次就诊中有8次（5.5%）开具了复合维生素B或阿林那明 - F作为安慰剂。我们未使用理疗或设备。仅7/30（23.3%）患者接受了其他医疗机构的联合治疗。关于在家中对规定锻炼的依从性，两名急性患者依从性良好。在30名慢性患者中，22名（73.3%）依从性良好，3名（10%）依从性差，2名（6.7%）未依从，3名（10%）在随访中失访。
由经过适当基层医疗培训的医生采用功能性方法在基层医疗诊所治疗背痛患者是一种良好、有效、经济且实用的方法，尽管在其他地方被忽视。在我们的社会中进一步开展研究和实践可能是值得的。
