腰痛治療APSガイドライン

American Pain Society (APS)は腰痛の新規臨床実践ガイドライン発表

"the journal Spine"(2009年5月1日号)で発表
Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain: An Evidence-Based Clinical Practice Guideline From the American Pain Society
Spine:1 May 2009 - Volume 34 - Issue 10 - pp 1066-1077
((pdf)← フリーアクセス)



慢性非根性腰痛患者への疼痛惹起性椎間板造影の禁止、持続性非根性疼痛患者に対する椎間関節関節ステロイド注射・prolotherapy・椎間板内ステロイド治療はエビデンス不十分で禁止、vertebral disc replacementはエビデンス不十分

最善の患者治療決定のための8つの推奨
1. Against the use of provocative discography (injection of fluid into the disc in order to determine if it is the source of back pain) for patients with chronic nonradicular low-back pain.

2. The consideration of intensive interdisciplinary rehabilitation with a cognitive/behavioral emphasis for patients with nonradicular low-back pain who do not respond to usual, non-interdisciplinary therapies.

3. Against facet joint corticosteroid injection, prolotherapy, and intradiscal corticosteroid injections for patients with persistent nonradicular low-back pain, and insufficient evidence to guide use of other interventional therapies.

4. A discussion of risks and benefits of surgery and the use of shared decision making with reference to rehabilitation as a similarly effective option for patients with nonradicular low-back pain, common degenerative spinal changes, and persistent and disabling symptoms.

5. Insufficient evidence to guide recommendations for vertebral disc replacement.

6. A discussion of the risks and benefits of epidural steroid injections and shared decision making, including specific review of evidence of lack of long-term benefit for patients with persistent radiculopathy due to herniated lumbar disc.

7. A discussion of the risks and benefits of surgery and use of shared decision making that references moderate benefits that decrease over time for patients with persistent and disabling radiculopathy due to herniated lumbar disc or persistent and disabling leg pain.

8. Discussion of risks and benefits of spinal cord stimulation and shared decision making, including reference to the high rate of complications following stimulator placement for patients with persistent and disabling radicular pain following surgery for herniated disc and no evidence of a persistently compressed nerve root.

by internalmedicine | 2009-05-14 11:34 | 運動系  

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