Baumgartner E, Vischer T L
Division de rhumatologie, HUG, Genève.
Schweiz Med Wochenschr. 1997 Nov 15;127(46):1901-10.
Despite advances in medical knowledge and available methods of treating spinal problems, the costs these problems generate are growing in a constant and exponential manner in western countries. Back pain is not different, commoner or more severe than in the past. This raises the question whether present-day management, which often runs counter to current scientific evidence, is appropriate. Practically speaking, so-called specific back pain is to be distinguished from nonspecific or common back pain. The former arises from a precise lesion (infectious, tumoral, inflammatory or traumatic), while the latter has no obvious underlying cause. Fortunately this preliminary differentiation is usually possible on the basis of the history and clinical workup alone. In this paper we deal solely with common back pain, as being by far the most frequent in everyday practice. Once a specific origin has been ruled out, the chief aim should be earliest possible resumption of the patient's normal activities. Various methods, embracing drug treatment, physiotherapy, and in appropriate cases ergotherapy, are available for this purpose. If this fails, the physician must react as rapidly as possible to prevent the condition becoming chronic. Regard should be had for the various psychosocial factors which interfere with the healing process, and a method should be adopted which is no longer based on the classic biomedical model but on a bio-psycho-social approach as proposed by Waddell. If necessary the patient should be referred to a specialist (rheumatologist, rehabilitation, orthopedist etc). Back pain is extremely widespread in the population at large and is a frequent reason why people consult a physician. On these grounds the primary care physician has a key role to play in the initial workup and also in the acute, subacute or chronic stage of the evolution. This review of the principles which should guide the practical approach to the back-pain patient is intended to aid the practitioner in his tasks of diagnosis and therapy.
尽管医学知识和治疗脊柱问题的现有方法取得了进展，但在西方国家，这些问题产生的成本正以持续且指数级的方式增长。背痛与过去相比并无不同，既不更常见也不更严重。这就引发了一个问题，即目前常常与当前科学证据相悖的治疗方法是否恰当。实际上，所谓的特异性背痛应与非特异性或普通背痛区分开来。前者源于精确的病变（感染性、肿瘤性、炎症性或创伤性），而后者没有明显的潜在病因。幸运的是，仅根据病史和临床检查通常就能进行这种初步区分。在本文中，我们仅探讨普通背痛，因为它在日常实践中最为常见。一旦排除了特异性病因，主要目标应是尽早让患者恢复正常活动。为此可采用多种方法，包括药物治疗、物理治疗，在适当情况下还可采用职业疗法。如果这些方法无效，医生必须尽快做出反应，以防止病情发展为慢性。应考虑到各种干扰愈合过程的社会心理因素，应采用一种不再基于经典生物医学模式、而是基于瓦德尔提出的生物 - 心理 - 社会方法的治疗方式。如有必要，应将患者转诊给专科医生（风湿病学家、康复专家、骨科医生等）。背痛在普通人群中极为普遍，是人们就医的常见原因。基于这些原因，初级保健医生在初步检查以及病情发展的急性、亚急性或慢性阶段都起着关键作用。这篇关于指导背痛患者实际治疗方法的原则综述旨在帮助从业者完成诊断和治疗任务。
