The American College of Physicians updated the guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain. Clinicians should reassure patients that acute or subacute low back pain usually improves over time, regardless of treatment. Thus, clinicians should avoid prescribing costly and potentially harmful treatments for these patients, especially narcotics. In addition, systemic steroids were not shown to provide benefit and should not be prescribed for patients with acute or subacute low back pain, even with radicular symptoms. For treatment of chronic low back pain, clinicians should select therapies that have the fewest harms and lowest costs (such as exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, etc.) because there were no clear comparative advantages for most treatments compared with one another. Clinicians should avoid prescribing costly therapies; those with substantial potential harms, such as long-term opioids (which can be associated with addiction and accidental overdose); and pharmacologic therapies that were not shown to be effective, such as tricyclic antidepressants or selective serotonin reuptake inhibitors. Source: http://annals.org/
美国医师学院更新了指南，提出证据，并提供关于非侵入性治疗腰痛的临床建议。临床医生应该向患者保证，无论如何治疗，急性或亚急性腰痛通常会随时间而改善。因此，临床医生应避免为这些患者开昂贵的和潜在有害的治疗，特别是麻醉剂。此外，全身性类固醇未显示有益，不应为急性或亚急性腰痛患者开出，甚至对有根性症状者。对于慢性腰痛的治疗，临床医生应该选择伤害最小和成本最低的治疗（例如运动，多学科复健，针灸，基于意念的减压，太极，瑜伽等），因为大多数治疗措施相互之间比较并无明确优势。临床医生应避免昂贵的治疗; 避免具有重大潜在危害的，如长期用鸦片类（可成瘾和意外过量）; 以及避免未显示有效的药物治疗，例如三环类抗抑郁药或选择性5-羟色胺再摄取抑制剂。来源：http://annals.org/