下背痛之評估與治療

Evaluation and Treatment of Low Back Pain

下背痛為一致病原因眾多的症狀，因此臨床醫師有時未能歸因於單一診斷故而稱之為非特異下背痛，可能造成生理、心理與經濟各方面之影響；下背痛評估除完整病史與理學檢查外，需謹記優先排除紅旗現象；多數下背痛症狀為自限性，於4至6周內緩解，治療之介入目標為緩解疼痛症狀及避免失能。文獻支持可採行之非手術治療包含藥物、注射、物理儀器治療、按摩、手法治療、衛教、運動治療與多團隊介入，依照疾病發生後之病程可採取不同治療方式，並給予病患心理支持與正確的疾病知識；部分患者可能重複發生下背痛，因此處理急性症狀之後，應該給予患者衛教及鼓勵規律運動，可以降低未來下背痛再發生機率。 Low back pain (LBP) is a symptom of diverse differential diagnoses. Physicians sometimes fail to attribute LBP to a single etiology, and so call ＂non-specific low back pain＂. It may affect physical, psychological and economic aspects. In addition to the comprehensive medical history and physical examinations, it is necessary to exclude the red flag sign during evaluation. Most LBP is self-limiting and resolve within 4 to 6 weeks. The treatment goals are to relieve pain and avoid pain-related disability. Evidence based conservative treatments include drug, injection, physical therapy, massage, manual therapy, health education, exercise therapy, and multidisciplinary intervention. Different treatment strategies can be applied according to the clinical course of LBP. Psychological support and correct disease knowledge should be given to the patients. Some LBP patients may experience repeated episodes. After treating acute symptoms, patients should be taught about health education and encourage regular exercise, which can reduce the chance of recurrence.