Chronic low-back pain(CLBP) is one of the most common pain conditions. Current clinical guidelines for low-back pain recommend acupuncture for CLBP. However, there are very few high-quality acupuncture studies on CLBP...Chronic low-back pain(CLBP) is one of the most common pain conditions. Current clinical guidelines for low-back pain recommend acupuncture for CLBP. However, there are very few high-quality acupuncture studies on CLBP in older adults. Clinical acupuncture experts in the American Traditional Chinese Medicine Association(ATCMA) were interested in the recent grant on CLBP research announced by the National Center for Complementary and Integrative Health. The ATCMA experts held an online discussion on the subject of real-world acupuncture treatments for CLBP in older adults. Seven participants, each with more than 20 years of acupuncture practice, discussed their own unique clinical experience while another participant talked about the potential mechanism of acupuncture in pain management. As a result of the discussion, a picture of a similar treatment strategy emerged across the participants for CLBP in older adults. This discussion shows that acupuncture may have complicated mechanisms in pain management, yet it is effective for the treatment of chronic pain involving maladaptive neuroplasticity;therefore, it should be effective for CLBP in older adults.展开更多
Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain p...Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain patients with lumbar disc herniation were treated with balanced acupuncture or body acupuncture. Central mechanisms of vaded acupunctures were compared using resting-state functional MRI. Patients from both groups received functional MRI before and after acupuncture. Functional connectivity in brain regions that were strongly associated with the bilatera amygdala was analyzed utilizing AFNI software. Visual analogue scale scores were greater in the balanced acupuncture group compared with the body acupuncture group. Function of the endogenous pain regulation network was enhanced in patients in the balanced acupuncture group, but was not changed in the body acupuncture group. This result indicates that the analgesic effects of body acupuncture do not work through the central nervous system. These data suggest that balanced acupuncture exerts analgesic effects on low-back and leg pain patients with lumbar disc herniation by regulating the function of the endogenous pain regulation network.展开更多
Background As one of the most common musculoskeletal ailments,chronic nonspecific low-back pain(CNLBP)causes persistent disability and substantial medical expenses.Epidemiological evidence shows that the incidence rat...Background As one of the most common musculoskeletal ailments,chronic nonspecific low-back pain(CNLBP)causes persistent disability and substantial medical expenses.Epidemiological evidence shows that the incidence rate of CNLBP in young and middle-aged people who are demanded rapidly recovery and social contribution is rising.Recent guidelines indicate a reduced role for medicines in the management of CNLBP.Objective The present study investigates the short-term effects of cupping and scraping therapy using a medicated balm,compared to nonsteroidal anti-inflammatory drug(NSAID)with a capsaicin plaster,in the treatment of CNLBP.Design,setting,participants and interventions We designed a prospective multicenter randomized clinical trial enrolling patients from January 1,2022 to December 31,2022.A total of 156 patients with CNLBP were randomized into two parallel groups.Diclofenac sodium-sustained release tablets were administered orally to participants in the control group for one week while a capsaicin plaster was applied externally.Patients in the test group were treated with cupping and scraping using a medical device and medicated balm.Main outcome measures Primary outcome was pain recorded using the visual analogue scale(VAS).Two secondary outcomes were recorded using the Japanese Orthopedic Association low-back pain scale(JOA)and the traditional Chinese medicine(TCM)syndrome integral scale(TCMS)as assessment tools.Results Between baseline and postintervention,all changes in outcome metric scales were statistically significant(P<0.001).Compared to the control group,patients in the test group had a significantly greater treatment effect in all outcome variables,as indicated by lower VAS and TCMS scores and higher JOA scores,after the one-week intervention period(P<0.001).Further,according to the findings of multivariate linear regression analysis,the participants’pain(VAS score)was related to their marital status,age,smoking habits and body mass index.No adverse reactions were reported for any participants in this trial.Conclusion The effectiveness of TCM combined with the new physiotherapy tool is superior to that of NSAID combined with topical plasters,regarding to pain intensity,TCM symptoms and quality of life.The TCM plus physiotherapy also showed more stable and long-lasting therapeutic effects.展开更多
目的观察电针联合悬吊训练(sling exercise therapy,SET)治疗慢性非特异性下腰痛(chronic nonspecific low back pain,CNLBP)的临床疗效。方法将72例CNLBP患者随机分为观察组和对照组,每组36例。对照组行SET治疗,观察组在对照组基础上...目的观察电针联合悬吊训练(sling exercise therapy,SET)治疗慢性非特异性下腰痛(chronic nonspecific low back pain,CNLBP)的临床疗效。方法将72例CNLBP患者随机分为观察组和对照组,每组36例。对照组行SET治疗,观察组在对照组基础上采用电针腰夹脊穴治疗。观察两组治疗前后视觉模拟评分法(visual analog scale,VAS)、腰椎功能障碍指数(oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedc Association,JOA)评分的变化,并比较两组治疗前后竖脊肌、多裂肌表面肌电图(surface electromyography,sEMG)中的指标均方根值(root mean square,RMS)和中位频率值(median frequency value,MF)。结果两组治疗2周后VAS、ODI评分低于治疗前,治疗后VAS、ODI评分低于治疗2周后和治疗前,差异有统计学意义(P<0.05);观察组治疗2周后和治疗后VAS、ODI评分低于对照组,差异有统计学意义(P<0.05)。两组治疗2周后JOA评分高于治疗前,治疗后JOA评分高于治疗2周后和治疗前,差异有统计学意义(P<0.05);观察组治疗2周后和治疗后JOA评分高于对照组,差异有统计学意义(P<0.05)。对照组竖脊肌、多裂肌双侧RMS值治疗2周后与治疗前比较,差异无统计学意义(P>0.05);治疗后竖脊肌、多裂肌双侧RMS值高于治疗2周后和治疗前,差异有统计学意义(P<0.05);观察组治疗2周后竖脊肌、多裂肌双侧RMS值高于治疗前,治疗后竖脊肌、多裂肌双侧RMS值高于治疗2周后和治疗前,差异有统计学意义(P<0.05);观察组治疗2周后、治疗后竖脊肌和多裂肌双侧RMS值高于对照组,差异有统计学意义(P<0.05)。两组治疗2周后竖脊肌、多裂肌双侧MF值高于治疗前,治疗后竖脊肌、多裂肌双侧MF值高于治疗2周后和治疗前,差异有统计学意义(P<0.05);观察组治疗2周后和治疗后竖脊肌、多裂肌双侧MF值高于对照组,差异有统计学意义(P<0.05)。结论电针联合SET训练能更好地减轻患者疼痛,改善椎旁核心肌(多裂肌、竖脊肌)的肌电信号,促进腰椎核心肌群功能恢复。展开更多
目的分析中国1990—2023年下腰痛疾病负担的变化趋势和归因危险因素,预测2030年下腰痛的相关疾病负担。方法基于2023年全球疾病负担研究(Global Burden of Disease,GBD)数据库,分析中国下腰痛人群1990—2023年的发病率、患病率、伤残损...目的分析中国1990—2023年下腰痛疾病负担的变化趋势和归因危险因素,预测2030年下腰痛的相关疾病负担。方法基于2023年全球疾病负担研究(Global Burden of Disease,GBD)数据库,分析中国下腰痛人群1990—2023年的发病率、患病率、伤残损失寿命年(years lived with disability,YLDs)和归因危险因素的特点及变化趋势,评估疾病负担的年龄与性别差异,通过自回归积分滑动平均模型与年龄-时期-队列模型对2030年疾病负担进行双模型联合预测。结果从1990年至2023年,中国下腰痛发病人数、患病人数、YLDs均呈上升趋势,分别由2998.91万例、6863.63万例、773.24万人年上升至4138.36万例、9532.40万例、1063.59万人年;发病率、患病率、YLDs率亦呈上升趋势,分别从2543.31/10万、5820.89/10万、655.77/10万上升至2892.65/10万、6663.01/10万、743.43/10万;然而年龄标准化发病率、患病率、YLDs率呈下降趋势,分别从2859.73/10万、6636.60/10万、740.83/10万下降至2164.80/10万、4929.78/10万、551.92/10万。下腰痛疾病负担呈现出女性明显高于男性且随年龄增加逐渐升高的特征(高峰为50~59岁)。归因分析示,吸烟、职业因素和高身体质量指数(body mass index,BMI)是导致YLDs增加的主要因素且存在性别差异。双模型显示,2023—2030年下腰痛的年龄标准化发病率、患病率和YLDs率将从2023年后呈逐年下降趋势。结论中国下腰痛疾病负担显示,1990—2023年中国人群的下腰痛负担逐年加重,吸烟、职业因素和高BMI是主要危险因素。预计到2030年,下腰痛的疾病负担将有所下降,但绝对疾病负担仍将维持高位,应关注疾病负担更重的中老年群体尤其是女性群体,并积极针对这些可控风险因素采取体质量控制与控烟管理等针对性措施。展开更多
目的:传统Meta分析证实运动干预可有效改善慢性腰背痛,但哪种特定的运动方式疗效更好目前证据还不够充分。鉴于此,此次研究通过网状Meta分析探讨不同运动要素改善成年人慢性腰背痛影响的差异。方法:检索PubMed、Web of Science、Embase...目的:传统Meta分析证实运动干预可有效改善慢性腰背痛,但哪种特定的运动方式疗效更好目前证据还不够充分。鉴于此,此次研究通过网状Meta分析探讨不同运动要素改善成年人慢性腰背痛影响的差异。方法:检索PubMed、Web of Science、Embase、Cochrane、中国知网、万方、维普数据库中运动干预非特异性慢性腰痛的随机对照试验,其中试验组进行任何形式的运动类型干预,对照组进行药物治疗、物理治疗等非运动干预,检索时限设为各数据库建库至2025-03-01,使用布尔逻辑运算符(AND/OR)组合关键词进行检索。由2位评价员独立完成文献筛选、信息提取及偏倚风险评估后,使用Stata 17.0软件进行网状Meta分析,利用累计排序概率图下面积(SUCRA)对运动剂量变量的影响效果进行排序。结果:①共纳入40项随机对照试验,网状Meta分析结果显示,核心稳定性训练、垫上运动、传统功法运动、组合运动、其他运动改善慢性腰背痛的效果优于对照组[SMD=-0.76,95%CI(-1.39,-0.13),P<0.05;SMD=-1.67,95%CI(-2.48,-0.86),P<0.05;SMD=-2.09,95%CI(-3.37,-0.80),P<0.05;SMD=-1.60,95%CI(-2.71,-0.49),P<0.05;SMD=-1.40,95%CI(-2.40,-0.40),P<0.05],悬吊训练改善慢性腰背痛的效果弱于传统功法运动和垫上运动[SMD=1.50,95%CI(0.05,2.95),P<0.05;SMD=1.09,95%CI(0.11,2.06),P<0.05],传统功法运动改善慢性腰背痛的效果优于核心稳定性训练[SMD=-1.32,95%CI(-2.64,-0.01),P<0.05];单次运动15-20 min、30-40 min的干预效果优于对照组[SMD=-1.96,95%CI(-3.55,-0.36),P<0.05;SMD=-1.44,95%CI(-2.12,-0.76),P<0.05],每周运动3次、六七次的干预效果优于对照组[SMD=-1.03,95%CI(-1.69,-0.37),P<0.05;SMD=-1.83,95%CI(-2.75,-0.91),P<0.05],每周运动六七次的干预效果优于每周运动一二次[SMD=-1.30,95%CI(-2.61,-0.06),P<0.05],运动4周、12-13周和≥16周的干预效果均显著优于对照组[SMD=-0.81,95%CI(-1.50,-0.12),P<0.05;SMD=-1.63,95%CI(-2.82,-0.43),P<0.05;SMD=-2.14,95%CI(-3.36,-0.92),P<0.05],运动≥16周的干预效果显著优于运动6周[SMD=-1.55,95%CI(-3.03,-0.07),P<0.05]。SUCRA结果显示,传统功法运动、单次运动15-20 min、每周运动六七次、运动≥16周在各自对应的因素中排名最高。结论:干预类型为传统功法(太极拳、气功、五禽戏、八段锦)、单次运动15-20 min、每周运动六七次、运动≥16周可能对成年人慢性腰背痛的缓解效果最佳。然而,由于纳入的研究数量有限,需要进一步的研究来提供更有力证据。展开更多
目的:探讨中医药治疗非特异性下腰痛(NLBP)临床研究的现状、热点及发展趋势,为今后的学术研究提供参考与借鉴。方法:检索中国知网(CNKI)、维普中文期刊服务平台(CSTJ)、万方数据知识服务平台(Wanfang Data)及Web of Science数据库(建库...目的:探讨中医药治疗非特异性下腰痛(NLBP)临床研究的现状、热点及发展趋势,为今后的学术研究提供参考与借鉴。方法:检索中国知网(CNKI)、维普中文期刊服务平台(CSTJ)、万方数据知识服务平台(Wanfang Data)及Web of Science数据库(建库至2025年5月31日),筛选中医药干预NLBP的临床文献。采用NoteExpress去重整理,运用CiteSpace和VOSviewer对作者、机构及关键词进行可视化计量分析。结果:共纳入文献501篇(中文460篇,英文41篇),2000—2025年间年度发文量呈波动增长,分为起步期(2000—2013年)、迅速发展期(2014—2020年)和平稳发展期(2021—2024年)3个阶段。作者与合作机构分析显示,中英文文献的作者及机构间合作均较为松散,未形成紧密协同网络。关键词分析表明,中文研究聚焦于“慢性非特异性下腰痛”“针灸”“推拿疗法”“中药”等临床治疗与疗效评价;英文研究则更关注“management”“disability”等疾病管理与功能改善。聚类与时间演化分析进一步揭示,研究热点从单一针灸疗法逐步拓展至推拿、运动疗法、电针及针药结合等综合治疗模式,并趋向于结合现代评估指标(如疼痛程度、腰椎功能、生活质量)进行多维度效果评价,呈现多方法融合与精细化、个性化的发展趋势。结论:中医药治疗NLBP的研究逐渐深入,具有广阔的发展前景。未来研究应加强多学科合作,提高临床研究质量,注重基础实验与临床应用的结合,深入解析作用机制。同时,应充分利用现代医学技术和人工智能,实现精准化、智能化治疗,促进该领域的可持续创新发展。此外,应构建基于病程阶段的“评估-干预-管理”三级体系,以提高治疗效果和患者生活质量。展开更多
Objective:To assess the efficacy and safety of Bushen Huoxue Formula(BSHXF)for the treatment of discogenic low-back pain(DLBP).Methods:This was a parallel,double-blind,randomized,clinical trial performed between May 2...Objective:To assess the efficacy and safety of Bushen Huoxue Formula(BSHXF)for the treatment of discogenic low-back pain(DLBP).Methods:This was a parallel,double-blind,randomized,clinical trial performed between May 2019 and June 2020.Seventy patients were assigned by computerized random number table to the treatment group(lumbar traction and BSHXF,35 cases)or the control group(lumbar traction and placebo,35 cases).The patients received intervention for 3 weeks.Assessment was conducted before treatment and at week 1,2,3 during treatment.Primary outcome was the self-reported score of Oswestry Disability Index(ODI).Secondary outcomes included Visual Analog Scale(VAS),clinical efficacy rate by minimal clinically important difference(MCID)as well as lumbar tenderness,muscle tone and lumbar spine mobility.Adverse reactions were recorded.Follow-up was performed at 1 and 3 months after the end of treatment.Results:In the treatment group,ODI score was significantly decreased compared with baseline(P<0.05)and the control group at 2-and 3-week treatment.Similarly,VAS score decreased compared with the baseline(P<0.05)and was lower than that in the control group at 2-and 3-week treatment(P<0.05).The clinical efficacy rate of the treatment group was higher than that of the control group after treatment[32.35%(11/34)vs.3.13%(1/32),P<0.05].Moreover,the tenderness,and muscle tone,as well as the back extension and left flexion in lumbar spine mobility in the treatment group at 3-week treatment were significantly improved compared with the control group(P<0.05).Follow-up showed that at 1-month after treatment,the treatment group had better outcomes than the control group with regard to a total score of ODI and VAS scores,as well as clinical efficacy rate(all P<0.05).Moreover,VAS score was still significantly lower than the control group at 3-month follow-up(P<0.05).No adverse reactions were reported during the study.Conclusion:BSXHF combined with lumbar traction can significantly improve the clinical symptoms including pain intensity,functionality,muscle tone,and lumbar spine mobility in DLBP patients.(Registration No.Chi CTR1900027777).展开更多
文摘Chronic low-back pain(CLBP) is one of the most common pain conditions. Current clinical guidelines for low-back pain recommend acupuncture for CLBP. However, there are very few high-quality acupuncture studies on CLBP in older adults. Clinical acupuncture experts in the American Traditional Chinese Medicine Association(ATCMA) were interested in the recent grant on CLBP research announced by the National Center for Complementary and Integrative Health. The ATCMA experts held an online discussion on the subject of real-world acupuncture treatments for CLBP in older adults. Seven participants, each with more than 20 years of acupuncture practice, discussed their own unique clinical experience while another participant talked about the potential mechanism of acupuncture in pain management. As a result of the discussion, a picture of a similar treatment strategy emerged across the participants for CLBP in older adults. This discussion shows that acupuncture may have complicated mechanisms in pain management, yet it is effective for the treatment of chronic pain involving maladaptive neuroplasticity;therefore, it should be effective for CLBP in older adults.
基金funded by the Scientific Research Innovation Program regarding Traditional Chinese Medicine of Guangzhou University of Chinese Medicine (Central mechanism of balanced acupuncture for lumbar disc herniationusing functional MRI), No. 09CX068
文摘Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain patients with lumbar disc herniation were treated with balanced acupuncture or body acupuncture. Central mechanisms of vaded acupunctures were compared using resting-state functional MRI. Patients from both groups received functional MRI before and after acupuncture. Functional connectivity in brain regions that were strongly associated with the bilatera amygdala was analyzed utilizing AFNI software. Visual analogue scale scores were greater in the balanced acupuncture group compared with the body acupuncture group. Function of the endogenous pain regulation network was enhanced in patients in the balanced acupuncture group, but was not changed in the body acupuncture group. This result indicates that the analgesic effects of body acupuncture do not work through the central nervous system. These data suggest that balanced acupuncture exerts analgesic effects on low-back and leg pain patients with lumbar disc herniation by regulating the function of the endogenous pain regulation network.
基金supported by the 13th Five-Year Army Key Discipline Construction Project(No.2020SZ06-17).
文摘Background As one of the most common musculoskeletal ailments,chronic nonspecific low-back pain(CNLBP)causes persistent disability and substantial medical expenses.Epidemiological evidence shows that the incidence rate of CNLBP in young and middle-aged people who are demanded rapidly recovery and social contribution is rising.Recent guidelines indicate a reduced role for medicines in the management of CNLBP.Objective The present study investigates the short-term effects of cupping and scraping therapy using a medicated balm,compared to nonsteroidal anti-inflammatory drug(NSAID)with a capsaicin plaster,in the treatment of CNLBP.Design,setting,participants and interventions We designed a prospective multicenter randomized clinical trial enrolling patients from January 1,2022 to December 31,2022.A total of 156 patients with CNLBP were randomized into two parallel groups.Diclofenac sodium-sustained release tablets were administered orally to participants in the control group for one week while a capsaicin plaster was applied externally.Patients in the test group were treated with cupping and scraping using a medical device and medicated balm.Main outcome measures Primary outcome was pain recorded using the visual analogue scale(VAS).Two secondary outcomes were recorded using the Japanese Orthopedic Association low-back pain scale(JOA)and the traditional Chinese medicine(TCM)syndrome integral scale(TCMS)as assessment tools.Results Between baseline and postintervention,all changes in outcome metric scales were statistically significant(P<0.001).Compared to the control group,patients in the test group had a significantly greater treatment effect in all outcome variables,as indicated by lower VAS and TCMS scores and higher JOA scores,after the one-week intervention period(P<0.001).Further,according to the findings of multivariate linear regression analysis,the participants’pain(VAS score)was related to their marital status,age,smoking habits and body mass index.No adverse reactions were reported for any participants in this trial.Conclusion The effectiveness of TCM combined with the new physiotherapy tool is superior to that of NSAID combined with topical plasters,regarding to pain intensity,TCM symptoms and quality of life.The TCM plus physiotherapy also showed more stable and long-lasting therapeutic effects.
文摘目的观察电针联合悬吊训练(sling exercise therapy,SET)治疗慢性非特异性下腰痛(chronic nonspecific low back pain,CNLBP)的临床疗效。方法将72例CNLBP患者随机分为观察组和对照组,每组36例。对照组行SET治疗,观察组在对照组基础上采用电针腰夹脊穴治疗。观察两组治疗前后视觉模拟评分法(visual analog scale,VAS)、腰椎功能障碍指数(oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedc Association,JOA)评分的变化,并比较两组治疗前后竖脊肌、多裂肌表面肌电图(surface electromyography,sEMG)中的指标均方根值(root mean square,RMS)和中位频率值(median frequency value,MF)。结果两组治疗2周后VAS、ODI评分低于治疗前,治疗后VAS、ODI评分低于治疗2周后和治疗前,差异有统计学意义(P<0.05);观察组治疗2周后和治疗后VAS、ODI评分低于对照组,差异有统计学意义(P<0.05)。两组治疗2周后JOA评分高于治疗前,治疗后JOA评分高于治疗2周后和治疗前,差异有统计学意义(P<0.05);观察组治疗2周后和治疗后JOA评分高于对照组,差异有统计学意义(P<0.05)。对照组竖脊肌、多裂肌双侧RMS值治疗2周后与治疗前比较,差异无统计学意义(P>0.05);治疗后竖脊肌、多裂肌双侧RMS值高于治疗2周后和治疗前,差异有统计学意义(P<0.05);观察组治疗2周后竖脊肌、多裂肌双侧RMS值高于治疗前,治疗后竖脊肌、多裂肌双侧RMS值高于治疗2周后和治疗前,差异有统计学意义(P<0.05);观察组治疗2周后、治疗后竖脊肌和多裂肌双侧RMS值高于对照组,差异有统计学意义(P<0.05)。两组治疗2周后竖脊肌、多裂肌双侧MF值高于治疗前,治疗后竖脊肌、多裂肌双侧MF值高于治疗2周后和治疗前,差异有统计学意义(P<0.05);观察组治疗2周后和治疗后竖脊肌、多裂肌双侧MF值高于对照组,差异有统计学意义(P<0.05)。结论电针联合SET训练能更好地减轻患者疼痛,改善椎旁核心肌(多裂肌、竖脊肌)的肌电信号,促进腰椎核心肌群功能恢复。
文摘目的分析中国1990—2023年下腰痛疾病负担的变化趋势和归因危险因素,预测2030年下腰痛的相关疾病负担。方法基于2023年全球疾病负担研究(Global Burden of Disease,GBD)数据库,分析中国下腰痛人群1990—2023年的发病率、患病率、伤残损失寿命年(years lived with disability,YLDs)和归因危险因素的特点及变化趋势,评估疾病负担的年龄与性别差异,通过自回归积分滑动平均模型与年龄-时期-队列模型对2030年疾病负担进行双模型联合预测。结果从1990年至2023年,中国下腰痛发病人数、患病人数、YLDs均呈上升趋势,分别由2998.91万例、6863.63万例、773.24万人年上升至4138.36万例、9532.40万例、1063.59万人年;发病率、患病率、YLDs率亦呈上升趋势,分别从2543.31/10万、5820.89/10万、655.77/10万上升至2892.65/10万、6663.01/10万、743.43/10万;然而年龄标准化发病率、患病率、YLDs率呈下降趋势,分别从2859.73/10万、6636.60/10万、740.83/10万下降至2164.80/10万、4929.78/10万、551.92/10万。下腰痛疾病负担呈现出女性明显高于男性且随年龄增加逐渐升高的特征(高峰为50~59岁)。归因分析示,吸烟、职业因素和高身体质量指数(body mass index,BMI)是导致YLDs增加的主要因素且存在性别差异。双模型显示,2023—2030年下腰痛的年龄标准化发病率、患病率和YLDs率将从2023年后呈逐年下降趋势。结论中国下腰痛疾病负担显示,1990—2023年中国人群的下腰痛负担逐年加重,吸烟、职业因素和高BMI是主要危险因素。预计到2030年,下腰痛的疾病负担将有所下降,但绝对疾病负担仍将维持高位,应关注疾病负担更重的中老年群体尤其是女性群体,并积极针对这些可控风险因素采取体质量控制与控烟管理等针对性措施。
文摘目的:探讨中医药治疗非特异性下腰痛(NLBP)临床研究的现状、热点及发展趋势,为今后的学术研究提供参考与借鉴。方法:检索中国知网(CNKI)、维普中文期刊服务平台(CSTJ)、万方数据知识服务平台(Wanfang Data)及Web of Science数据库(建库至2025年5月31日),筛选中医药干预NLBP的临床文献。采用NoteExpress去重整理,运用CiteSpace和VOSviewer对作者、机构及关键词进行可视化计量分析。结果:共纳入文献501篇(中文460篇,英文41篇),2000—2025年间年度发文量呈波动增长,分为起步期(2000—2013年)、迅速发展期(2014—2020年)和平稳发展期(2021—2024年)3个阶段。作者与合作机构分析显示,中英文文献的作者及机构间合作均较为松散,未形成紧密协同网络。关键词分析表明,中文研究聚焦于“慢性非特异性下腰痛”“针灸”“推拿疗法”“中药”等临床治疗与疗效评价;英文研究则更关注“management”“disability”等疾病管理与功能改善。聚类与时间演化分析进一步揭示,研究热点从单一针灸疗法逐步拓展至推拿、运动疗法、电针及针药结合等综合治疗模式,并趋向于结合现代评估指标(如疼痛程度、腰椎功能、生活质量)进行多维度效果评价,呈现多方法融合与精细化、个性化的发展趋势。结论:中医药治疗NLBP的研究逐渐深入,具有广阔的发展前景。未来研究应加强多学科合作,提高临床研究质量,注重基础实验与临床应用的结合,深入解析作用机制。同时,应充分利用现代医学技术和人工智能,实现精准化、智能化治疗,促进该领域的可持续创新发展。此外,应构建基于病程阶段的“评估-干预-管理”三级体系,以提高治疗效果和患者生活质量。
基金Supported by National Natural Science Foundation of China(No.81930118)Central Public Welfare Research Institutes(No.ZZ13-YQ-038)+1 种基金Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine(No.ZYYCXTD-C-202003)National Key R&D Program of China(No.2021YFC1712800)。
文摘Objective:To assess the efficacy and safety of Bushen Huoxue Formula(BSHXF)for the treatment of discogenic low-back pain(DLBP).Methods:This was a parallel,double-blind,randomized,clinical trial performed between May 2019 and June 2020.Seventy patients were assigned by computerized random number table to the treatment group(lumbar traction and BSHXF,35 cases)or the control group(lumbar traction and placebo,35 cases).The patients received intervention for 3 weeks.Assessment was conducted before treatment and at week 1,2,3 during treatment.Primary outcome was the self-reported score of Oswestry Disability Index(ODI).Secondary outcomes included Visual Analog Scale(VAS),clinical efficacy rate by minimal clinically important difference(MCID)as well as lumbar tenderness,muscle tone and lumbar spine mobility.Adverse reactions were recorded.Follow-up was performed at 1 and 3 months after the end of treatment.Results:In the treatment group,ODI score was significantly decreased compared with baseline(P<0.05)and the control group at 2-and 3-week treatment.Similarly,VAS score decreased compared with the baseline(P<0.05)and was lower than that in the control group at 2-and 3-week treatment(P<0.05).The clinical efficacy rate of the treatment group was higher than that of the control group after treatment[32.35%(11/34)vs.3.13%(1/32),P<0.05].Moreover,the tenderness,and muscle tone,as well as the back extension and left flexion in lumbar spine mobility in the treatment group at 3-week treatment were significantly improved compared with the control group(P<0.05).Follow-up showed that at 1-month after treatment,the treatment group had better outcomes than the control group with regard to a total score of ODI and VAS scores,as well as clinical efficacy rate(all P<0.05).Moreover,VAS score was still significantly lower than the control group at 3-month follow-up(P<0.05).No adverse reactions were reported during the study.Conclusion:BSXHF combined with lumbar traction can significantly improve the clinical symptoms including pain intensity,functionality,muscle tone,and lumbar spine mobility in DLBP patients.(Registration No.Chi CTR1900027777).
