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首页> 外文期刊>Patient Safety in Surgery >Impact of a multidisciplinary pain program for the management of chronic low back pain in patients undergoing spine surgery and primary total hip replacement: a retrospective cohort study
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Impact of a multidisciplinary pain program for the management of chronic low back pain in patients undergoing spine surgery and primary total hip replacement: a retrospective cohort study

机译：一项多学科疼痛计划对脊柱外科手术和主要全髋关节置换患者慢性下腰痛的管理的影响：一项回顾性队列研究

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Background Low back pain is a very common disorder. In this field chronic low back pain represents a special challenge. The management of chronic low back pain consists of a range of different intervention strategies. Usually operative intervention should be avoided if possible. However, there are constellations were surgical therapy in patients with chronic low back pain seems to be meaningful. The aim of this study was to investigate the clinical outcomes after spine surgery and hip replacement in patients with chronic low back pain after undergoing a structured rehabilitation program including cognitive – behavioral therapy. Methods From January 1, 2007 to January 1, 2010 patients were indicated for total hip replacement (THA) or spine surgery after receiving inpatient multidisciplinary pain programs including cognitive – behavioral therapy at our orthopedic institute with a specialized unit for the rehabilitation of chronic pain patients. Indications for surgery were based on the synopsis of clinical and imaging findings and on positive effects after local injections during the multidisciplinary pain program. The tools for assessment included follow-up at 6 and 12 months and analyses of pain, chronicity, physical functioning and depression. Results Of the 256 patients admitted for multidisciplinary pain program, fifteen were indicated to benefit from a surgical intervention during multidisciplinary pain program. Ten patients received spine surgery. THA was indicated in five patients. In all cases, the peri- and postoperative clinical courses were uneventful. Only two of the patients subjected to spine surgery and three patients who had THA were improved after 12 months. One patient reported a worsened condition. All patients presented with good functional outcomes and normal radiological findings. Conclusions The indication for surgical intervention in patients with chronic low back pain and degenerative diseases must be critically assessed. THA in this cohort should focus on functional aspects, such as the improvement of range of motion, rather than the reduction of pain. Spine surgery in chronic low back pain patients after multidisciplinary pain program including cognitive – behavioral therapy cannot be recommended due to its questionable success.
机译：背景腰痛是一种非常常见的疾病。在该领域，慢性腰痛是一个特殊的挑战。慢性下腰痛的治疗包括一系列不同的干预策略。通常应尽可能避免手术干预。但是，有星座者对慢性腰痛患者进行手术治疗似乎是有意义的。这项研究的目的是研究接受包括认知行为疗法在内的结构性康复计划后，慢性腰背痛患者的脊柱手术和髋关节置换术后的临床结局。方法从2007年1月1日至2010年1月1日，在我们的骨科医院接受患者多学科疼痛计划（包括认知行为疗法）的患者，接受全髋关节置换术（THA）或脊柱外科手术治疗，该部门设有专门的慢性疼痛患者康复科。手术指征基于临床和影像学发现的概述，以及在多学科疼痛计划中局部注射后的积极作用。评估工具包括6个月和12个月的随访以及疼痛，慢性，身体功能和抑郁的分析。结果在256名接受多学科疼痛治疗的患者中，有15名在多学科疼痛治疗过程中受益于手术干预。十名患者接受了脊柱手术。在五名患者中指出了THA。在所有情况下，围手术期和术后的临床过程都很顺利。 12个月后，只有2例接受脊柱手术的患者和3例THA的患者得到了改善。一名患者报告病情恶化。所有患者均表现出良好的功能预后和放射学正常。结论必须严格评估对慢性下腰痛和退行性疾病患者进行手术干预的适应症。在这个队列中，THA应该侧重于功能方面，例如改善运动范围，而不是减轻疼痛。对于慢性腰背痛患者进行多学科疼痛治疗（包括认知行为疗法）后进行脊柱外科手术，由于其成功率令人怀疑，因此不建议使用。

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