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A Patient’s Guide to Treatment Guidelines for Low Back Pain Introduction 引言 In the United States low back pain is ranked number five among the most common reasons for physician office visits. Of the patients who get medical care, they usually improve rapidly in the first month. However, up to one-third of patients report chronic back pain of at least moderate severity. 在美国，下腰痛是就诊最常见病因中排名第五的疾病。获得医疗护理的患者，在一个月中症状可快速缓解。然而，高达三分之一的患者仍具有中等程度的下背痛。 Many diagnostic tests and treatments have been tried for low back pain. Many things may be suggested, but have little evidence to show their worth. Diagnostic tests and treatments for low back pain can also be costly. In 1998, it is estimated that 26.3 million dollars were spent in the U.S. on health care for low back pain.Some were considered proven even with small benefits if there were no significant harms, costs, or burdens. 许多诊断的检查和治疗方法已尝试用于下腰痛中。许多事情可能会被建议做，但很少有证据表明它们的价值。诊断的检查和治疗下腰痛也可花费昂贵。据估计在1998年，美国花费2.63千万美元用于下腰痛的健康保健。一些措施如果没有显著的危害，花费或负担，且被证明对于下腰痛具有少量的益处。 This guide will give you a general overview of the newly recommended guidelines for the evaluation, diagnosis, and treatment of acute and chronic low back pain in adults. 本指南将给你新推荐用于评估、诊断和治疗成人急慢性腰痛的概述。 This guide will help you understand：
本指南将帮助你理解：
Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). 建议1：临床医生应进行集中的病史采集和体格检查来帮助下腰痛患者确定是一下3中疾病中的哪一类分型：非特异性下腰痛、腰背痛与潜在的神经根受压或椎管狭窄相关，或者腰背部疼痛与其他特点脊柱因素相关。病史包括评估社会心理危险因素，这可预测慢性下背痛致残性的风险（强烈推荐，中等质量证据）。 Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain(strong recommendation, moderate-quality evidence). 建议2：临床医生对非特异性下腰痛患者不该常规进行影像学检查或其他诊断检查在（强烈推荐，中等质量证据）。 Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). 建议3：当腰痛患者存在严重或进展性的神经功能缺损，或在病史采集和体格检查后怀疑有严重基础疾病的情况，临床医生应进行诊断性影像学检查（强烈推荐，中等质量证据）。 Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with MRI (preferred) or CT only if they are potential candidates for surgery or epidural steroid injection (strong recommendation, moderate-quality evidence). 建议4：临床医生应评估患者持续下腰痛的时间、症状、使用MRI（首选）或CT检查评估神经根症状或椎管狭窄情况，这仅在具有潜在行手术治疗或者硬膜外类固醇注射治疗的患者中应用（强烈推荐，中等质量证据）。 Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). 建议5：临床医生应为患者提供预期下腰痛的循证医学信息，建议患者保持积极乐观的心态，并提供有效的自我保健措施（强烈推荐，中等质量证据）。 Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs(NSAIDs). 建议6：对于腰痛患者，临床医生应考虑使用已证明有益处的药物结合腰背部护理及自我护理。临床医生应评估基线疼痛，功能障碍，潜在益处，风险，和在治疗前长期相对缺乏有效性和安全性资料的程度（强烈推荐，中等质量证据）。对于大多数患者的一线治疗药物为对乙酰氨基酚或非甾体类抗炎药（NSAIDs）。 Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of non pharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence). 建议7：对那些不改善自我生活习惯的患者，临床医生应考虑非药物治疗----对于急性下腰痛的患者，脊柱推拿被证实更有效果，对慢性或亚急性下腰痛患者，加强多学科康复、运动疗法、针灸、按摩疗法、脊柱推拿、瑜伽，认知行为疗法，或进行性放松（弱推荐，中等质量证据）。
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