Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain An Evidence-Based Clinical Practice Guideline From the American Pain Society

被引：404

作者：

Chou, Roger ^{[1
]}

Loeser, John D. ^{[2
]}

Owens, Douglas K. ^{[3
]}

Rosenquist, Richard W. ^{[5
]}

Atlas, Steven J. ^{[6
]}

Baisden, Jamie ^{[7
]}

Carragee, Eugene J. ^{[4
]}

Grabois, Martin ^{[8
]}

Murphy, Donald R. ^{[9
]}

Resnick, Daniel K. ^{[10
]}

Stanos, Steven P. ^{[11
]}

Shaffer, William O. ^{[12
]}

Wall, Eric M. ^{[13
]}

机构：

[1] Oregon Hlth & Sci Univ, Dept Med, Oregon Evidence Based Practice Ctr, Portland, OR 97201 USA

[2] Univ Washington, Dept Neurol Surg, Seattle, WA 98195 USA

[3] Vet Affairs Med Ctr, Palo Alto, CA 94304 USA

[4] Stanford Univ, Dept Orthoped Surg, Stanford, CA 94305 USA

[5] Univ Iowa, Dept Anesthesiol, Iowa City, IA USA

[6] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Med Serv,Gen Med Div, Boston, MA USA

[7] Med Coll Wisconsin, Dept Neurosurg, Milwaukee, WI 53226 USA

[8] Baylor Coll Med, Inst Rehabil & Res, Dept Phys Med & Rehabil, Houston, TX 77030 USA

[9] Brown Univ, Alpert Med Sch, Rhode Isl Spine Ctr, Dept Community Hlth, Pawtucket, RI USA

[10] Univ Wisconsin, Dept Neurosurg, Madison, WI USA

[11] Northwestern Univ, Dept Phys Med & Rehabil, Chicago, IL 60611 USA

[12] Univ Kentucky, Dept Orthopaed, Lexington, KY USA

[13] Qualis Hlth, Seattle, WA USA

来源：

SPINE | 2009年 / 34卷 / 10期

关键词：

low back pain; guideline; evidence-based; surgery; fusion; laminectomy; discectomy; injection; radiofrequency denervation; intradiscal electrothermal therapy; botulinum toxin; interdisciplinary therapy; multidisciplinary therapy; spinal cord stimulation; RANDOMIZED CONTROLLED-TRIAL; SPINAL-CORD STIMULATION; LUMBAR-DISK HERNIATION; EPIDURAL CORTICOSTEROID INJECTIONS; DOUBLE-BLIND EVALUATION; UNITED-STATES TRENDS; PROVOCATIVE DISCOGRAPHY; RADICULAR PAIN; NERVE-ROOT; FOLLOW-UP;

D O I：

10.1097/BRS.0b013e3181a1390d

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study Design. Clinical practice guideline. Objective. To develop evidence-based recommendations on use of interventional diagnostic tests and therapies, surgeries, and interdisciplinary rehabilitation for low back pain of any duration, with or without leg pain. Summary of Background Data. Management of patients with persistent and disabling low back pain remains a clinical challenge. A number of interventional diagnostic tests and therapies and surgery are available and their use is increasing, but in some cases their utility remains uncertain or controversial. Interdisciplinary rehabilitation has also been proposed as a potentially effective noninvasive intervention for persistent and disabling low back pain. Methods. A multidisciplinary panel was convened by the American Pain Society. Its recommendations were based on a systematic review that focused on evidence from randomized controlled trials. Recommendations were graded using methods adapted from the US Preventive Services Task Force and the Grading of Recommendations, Assessment, Development, and Evaluation Working Group. Results. Investigators reviewed 3348 abstracts. A total of 161 randomized trials were deemed relevant to the recommendations in this guideline. The panel developed a total of 8 recommendations. Conclusion. Recommendations on use of interventional diagnostic tests and therapies, surgery, and interdisciplinary rehabilitation are presented. Due to important trade-offs between potential benefits, harms, costs, and burdens of alternative therapies, shared decision-making is an important component of a number of the recommendations.

引用

页码：1066 / 1077

页数：12

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