요통의 진단과 치료
Diagnosis and Management of Low Back Pain
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초록
Low back pain is a common clinical condition with heterogeneous causes and challenges to manage. High prevalence and numerous assessments result in an enormous socioeconomic burden. Clinician must conduct efficient and stepwise evaluation process to rule out serious spinal pathology, neurologic involvement, and identify risk factors for chronicity. The process can be achieved through the focused history taking and physical examination. Certain factors related to serious spinal pathology include age (>50 years), trauma, unexplained fever, recent urinary or skin infection, unrelenting night or rest pain,unexplained weight loss, osteoporosis, immunosuppression, steroid use, and widespread neurological symptoms. In non-specific low back pain, diagnostic imaging and laboratory studies are often unnecessary and can disturb an appropriate management. For the management of acute low back pain, patient education and medication such as acetaminophen, non-steroidal anti-inflammatory drugs, and muscle relaxants are recommended. For chronic low back pain, behavior therapy, back exercise,and spinal manipulation are beneficial. The evidence based approach could improve success rate of management, result in prevention of acute low back pain from being chronic intractable pain.
Abstract
Low back pain is a common clinical condition with heterogeneous causes and challenges to manage. High prevalence and numerous assessments result in an enormous socioeconomic burden. Clinician must conduct efficient and stepwise evaluation process to rule out serious spinal pathology, neurologic involvement, and identify risk factors for chronicity. The process can be achieved through the focused history taking and physical examination. Certain factors related to serious spinal pathology include age (>50 years), trauma, unexplained fever, recent urinary or skin infection, unrelenting night or rest pain,unexplained weight loss, osteoporosis, immunosuppression, steroid use, and widespread neurological symptoms. In non-specific low back pain, diagnostic imaging and laboratory studies are often unnecessary and can disturb an appropriate management. For the management of acute low back pain, patient education and medication such as acetaminophen, non-steroidal anti-inflammatory drugs, and muscle relaxants are recommended. For chronic low back pain, behavior therapy, back exercise,and spinal manipulation are beneficial. The evidence based approach could improve success rate of management, result in prevention of acute low back pain from being chronic intractable pain.
참고문헌 (48)
- Luo X, "Estimates and patterns of direct health care expenditures among individuals with back pain in the United States", Spine (Phila Pa 1976), 29, pp.79~86 (2004)
- Von Korff M, "The course of back pain in primary care", Spine (Phila Pa 1976), 21, pp.2833~2839 (1996)
- Frymoyer JW, "An overview of the incidences and costs of low back pain", Orthop Clin North Am, 22, pp.263~271 (1991)
- Chou R, "Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society", Ann Intern Med, 147, pp.478~491 (2007)
- Cohen SP, "Management of low back pain", BMJ, 337, pp.2718~ (2008)
- Charles Cho S, "Utility of electrodiagnostic testing in evaluating patients with lumbosacral radiculopathy: An evidence-based review", Muscle Nerve, 42, pp.276~282 (2010)
- van Tulder MW, "Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies", Spine (Phila Pa 1976), 22, pp.427~434 (1997)
- Deyo RA, "What can the history and physical examination tell us about low back pain?", JAMA, 268, pp.760~765 (1992)
- Deyo RA, "Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies", J Gen Intern Med, 3, pp.230~238 (1988)
- Jarvik JG, "Diagnostic evaluation of low back pain with emphasis on imaging", Ann Intern Med, 137, pp.586~597 (2002)
- Rudwaleit M, "Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria", Arthritis Rheum, 54, pp.569~578 (2006)
- van den Hoogen HM, "On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice. A criteria-based review of the literature.", Spine (Phila Pa 1976), 20, pp.318~327 (1995)
- Vroomen PC, "Diagnostic value of history and physical examination in patients suspected of sciatica due to disc herniation: a systematic review", J Neurol, 246, pp.899~906 (1999)
- Deville WL, "The test of Lasegue: systematic review of the accuracy in diagnosing herniated discs", Spine (Phila Pa 1976), 25, pp.1140~1147 (2000)
- de Graaf I, "Diagnosis of lumbar spinal stenosis: a systematic review of the accuracy of diagnostic tests", Spine (Phila Pa 1976), 31, pp.1168~1176 (2006)
- Hancock MJ, "Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain", Eur Spine J, 16, pp.1539~1550 (2007)
- Cohen SP, "Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain", Anesthesiology, 106, pp.591~614 (2007)
- Fayad F, "Chronicity, recurrence, and return to work in low back pain: common prognostic factors", Ann Readapt Med Phys, 47, pp.179~189 (2004)
- Pincus T, "A systematic review of psychological factors as predictors of chronicity", disability in prospective cohorts of low back pain, 2002, pp.27, 109~120
- Steenstra IA, "Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature", Occup Environ Med, 62, pp.851~860 (2005)
- Pengel LH, "Acute low back pain: systematic review of its prognosis", BMJ, 327, pp.323~ (2003)
- Hestbaek L, "Low back pain: what is the long-term course? A review of studies of general patient populations", Eur Spine J, 12, pp.149~165 (2003)
- Dagenais S, "Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines", Spine J, 10, pp.514~529 (2010)
- Deyo RA, "Reducing roentgenography use. Can patient expectations be altered?", Arch Intern Med, 147, pp.141~145 (1987)
- Kendrick D, "Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial", BMJ, 322, pp.400~405 (2001)
- Kerry S, "Radiography for low back pain: a randomised controlled trial and observational study in primary care", Br J Gen Pract, 52, pp.469~474 (2002)
- Jarvik JG, "Imaging of adults with low back pain in the primary care setting", Neuroimaging Clin N Am, 13, pp.293~305 (2003)
- Jarvik JG, "Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial", JAMA, 289, pp.2810~2818 (2003)
- Lurie JD, "Rates of advanced spinal imaging and spine surgery", Spine (Phila Pa 1976), 28, pp.616~620 (2003)
- Loblaw DA, "Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative's Neuro-Oncology Disease Site Group", J Clin Oncol, 23, pp.2028~2037 (2005)
- Todd NV, "Cauda equina syndrome: the timing of surgery probably does influence outcome", Br J Neurosurg, 19, pp.301~308 (2005)
- Date ES, "Cervical paraspinal spontaneous activity in asymptomatic subjects", MUSCLE & NERVE, 34(3), pp.361~364 (2006), Amercian Association of Neuromuscular Disorder and Electrodiagnostic Medicine
- Nardin RA, "Fibrillations in lumbosacral paraspinal muscles of normal subjects", Muscle Nerve, 21, pp.1347~1349 (1998)
- Kim BJ, "Electromyographic technique for lumbar multifidus examination: Comparison of previous techniques used to localize the multifidus", ARCH PHYS MED REHABIL, 86(7), pp.1325~1329 (2005), Elsevier
- Hagen KB, "Bed rest for acute low-back pain and sciatica", Cochrane Database Syst Rev, pp.001254~ (2004)
- Hilde G, "Advice to stay active as a single treatment for low back pain and sciatica", Cochrane Database Syst Rev, pp.003632~ (2002)
- French SD, "Superficial heat or cold for low back pain", Cochrane Database Syst Rev, pp.CD004750~ (2006)
- Kovacs FM, "Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial", Lancet, 362, pp.1599~1604 (2003)
- Bair MJ, "Depression and pain comorbidity: a literature review", Arch Intern Med, 163, pp.2433~2445 (2003)
- McCleane GJ, "Does gabapentin have an analgesic effect on background, movement and referred pain? A randomised, doubleblind, placebo controlled study", The Pain Clinic, 13, pp.103~107 (2001)
- Yildirim K, "The effectiveness of gabapentin in patients with chronic radiculopathy", The Pain Clinic, 15, pp.213~218 (2003)
- van Tulder MW, "Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the cochrane collaboration", Spine (Phila Pa 1976), 28, pp.1978~1992 (2003)
- Assendelft WJ, "Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies", Ann Intern Med, 138, pp.871~881 (2003)
- Hayden JA, "Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain", Ann Intern Med, 142, pp.776~785 (2005)
- Furlan AD, "Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group", Spine (Phila Pa 1976), 27, pp.1896~1910 (2002)
- Sherman KJ, "Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial", Ann Intern Med, 143, pp.849~856 (2005)
- Ostelo RW, "Behavioural treatment for chronic low-back pain", Cochrane Database Syst Rev, pp.002014~ (2005)
- Weinstein JN, "Surgical versus nonsurgical therapy for lumbar spinal stenosis", N Engl J Med, 358, pp.794~810 (2008)