醫病共享決策應用於衰弱下背痛

Shared Decision Making in Low Back Pain of Fragility

老年衰弱引起的下背痛（fragility low back pain）是一種臨床上表現為疼痛，骨折和肢體殘疾的病理狀況，導致喪失獨立性和長期護理的需要。慢性疼痛是一種涉及感官，情感和認知方面的綜合表現，老化的過程會加劇這方面所經歷的痛苦，慢性疼痛具有傷害性和神經性疼痛的感覺特性，因此，對它的評估和治療，需要一種針對該人群特定特徵的整體方法，疼痛管理必須包括藥理學方法（pharmacological approach），物理治療（physiotherapy interventions），衛教措施（education），以及在嚴重情況下搭配手術治療（surgical treatment）。治療老年衰弱引起的下背痛需要整體評估疼痛、身體機能、生活習性、藥物服用狀況（骨鬆用藥）及鈣和維生素D、繼發原因（secondary causes）等多方面綜述，非常適合醫病共享決策模式（shared decision making, SDM），透過醫病溝通，病患可自由表達自身對治療選項的偏好、期待目標及價值觀，最後共同找出慢性疼痛的最合適解決方案。

Lower back pain caused by old age frailty is a pathological condition that is clinically manifested as pain, fracture and limb disability, leading to dependency and the need for long-term care. Chronic pain is a complicated condition involving senses, emotion and cognition. The process of aging will aggravate the pain experienced. Chronic pain has the sensory characteristics of noxious and neuropathic pain. Therefore, its evaluation and treatment require a holistic approach to the specific characteristics of the population. Pain management must include pharmacological methods, physical therapy, health education, and combined surgical treatment in most cases. The treatment of lower back pain caused by senile frailty requires a comprehensive assessment of pain, physical function, lifestyle habits, drug use (osteoporosis medication), calcium and vitamin D, and diagnosis of secondary causes. It is very suitable for a shared decision-making model for doctors and patients. Through communication, patients can freely express their preferences for treatment options, expectations and values, and finally find the most suitable solution for themselves.