Braddom R L
Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, USA.
Semin Neurol. 1998;18(2):197-210. doi: 10.1055/s-2008-1040873.
This article examines the current treatment of low back pain in light of the recent Agency for Health Care Practice and Research (AHCPR) guidelines on the acute management of low back pain (the AHCPR is an agency of the federal government). The article describes the most important history questions, the most helpful physical signs, and the most practical examination techniques. Considerable emphasis is placed on ruling out the "red flag" diagnoses that require immediate treatment. The article agrees with the AHCPR that if the red flags of cancer, infection, fracture, and neurologic deficit are ruled out, most of the remaining causes of acute back pain are largely self-healing over 4-8 weeks. Emphasis is placed on using the history and physical examination rather than expensive studies to rule out the red flag cases, so that cost-effective management of low back pain is possible. The author also reviews the ten top causes of low back pain and their evaluation and treatment.
本文根据医疗保健实践与研究机构（AHCPR，联邦政府的一个机构）近期发布的关于腰痛急性处理的指南，审视了当前腰痛的治疗方法。文章描述了最重要的病史问题、最有帮助的体征以及最实用的检查技术。重点强调了排除需要立即治疗的“警示信号”诊断。本文认同AHCPR的观点，即如果排除了癌症、感染、骨折和神经功能缺损等警示信号，大多数其余的急性背痛病因在4至8周内大多可自愈。重点在于利用病史和体格检查而非昂贵的检查来排除警示信号病例，从而实现腰痛的经济有效管理。作者还回顾了腰痛的十大主要病因及其评估与治疗方法。
