腰椎疼痛怎样治疗
腰椎疼痛如何治疗配图，仅供参考
TreatmentEducation and activity modification
After ruling out serious aetiologies,treatment plans with the goals of pain relief,functional improvement and minimisation of time off work can be formulated with the patient.) For patients with non-specific acute low back pain,evidence shows that individualised patient education is more effective than no education in relieving a patient’s pain.) The discussion with the patient should involve explaining the benign nature of the pain,with reassurance that improvement will happen with time. The patient should be educated on the importance of adopting a good posture when sitting or standing,as well as proper lifting techniques,such as bending at the knees when lifting heavy objects and avoiding excessively twisting and bending when doing so. Workplace and/or work-from-home ergonomics should be discussed with patients,so that they can implement changes that will help to improve posture and reduce back pain. The patient should also be advised against bed rest. It is less effective than staying active in terms of relieving pain and improving function.) Prolonged bed rest will lead to muscle wasting,joint stiffness and an overall decrease in function for patients. It can even lead to serious consequences such as pressure ulcers and venous thromboembolism.
Physical therapy
Patients should be encouraged to start physiotherapy early for the treatment of low back pain. Physiotherapist-directed home exercises are effective in relieving pain,reducing recurrence and improving overall function. These exercises are generally divided into movement exercises and strengthening exercises. Movement and stretching exercises,including the McKenzie method,help to restore movement and minimise stiffness,which in turn relieves back pain. Strengthening exercises help to improve core muscle stability,preventing further strain on the back and improving overall back stability. These exercise programmes are a cost-effective treatment for low back pain,increasing time intervals between episodes of back pain and reducing time off work.)
Simple stretches include the knee-to-chest stretch and lower back rotational stretch. In the knee-to-chest stretch,the patient is advised to lie supine on the floor and pull one knee towards the chest and hold it against the chest for five seconds before repeating with the other knee. In the lower back rotational stretch,the patient is advised to lie supine on the floor,keeping the shoulders firmly on the floor. Next,the patient needs to roll both bent knees to one side,holding the position for 5–10 seconds,before rolling both knees to the other side. Another simple method for relieving back pain is getting the patient to lie supine on the floor and placing a tennis ball between the back and the floor,particularly on the areas of the back where the muscles are tight. Simple side-to-side rolling actions can be performed,releasing the tight muscles and relieving the pain ).
[](https://ncbi.nlm.nih.gov/pmc/articles/PMC8801838/figure/F3/)
[Open in a separate window](https://ncbi.nlm.nih.gov/pmc/articles/PMC8801838/figure/F3/?report=objectonly) [Fig. 3](https://ncbi.nlm.nih.gov/pmc/articles/PMC8801838/figure/F3/)
Illustration shows a tennis ball under the back.
Application of ice on the acute onset of low back pain may also provide short-term relief of pain and improvement of disability.) However,it may not be useful beyond early low back pain.
Other methods for pain relief include acupuncture,) the use of lumbar support,) massage) and chiropractic spinal manipulation.) These modes may produce short-term pain relief but are generally not supported by strong,high-quality evidence.
Pharmacological therapy
Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first-line therapy. They are effective in providing short-term relief. Notably,NSAIDs are no more effective than acetaminophen,and there is no NSAID that is superior. However,for some patients,if the first NSAID is ineffective,switching to a different one may also be considered.) Prior to starting on NSAIDs,it is important to review the patient’s profile,with consideration of risk factors such as the presence of renal impairment and cardiovascular diseases. NSAIDs should be used at the lowest effective dose for the shortest possible period of time) and should not be taken continuously. The patient should be reviewed in 1–2 weeks if the pain has not significantly improved.
Taking guidance from the World Health Organization analgesic ladder,opioids,another commonly prescribed drug for pain relief in low back pain,can then be considered in persistent pain despite NSAIDs. However,it is to be noted that some studies have shown no difference in pain relief and time off work between NSAIDs and opioids.) In addition,opioids have a risk of harmful dose escalation over time. Opioids also have significant adverse effects such as drowsiness,nausea and dizziness,requiring the physician’s discretion for cautious use.","department":"
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