16/06/2026
【下背痛，是我很喜歡處理的問題之一】
因為當患者痛苦走進診間，用神奇的讚嘆離開針灸室的時候，真的很有成就感。
但我也常跟患者說，雖然我可以幫你修理這次的問題，但我們還是要一起找出原因，避免反覆發作。
臨床上，除了針灸與徒手治療，面對慢性下背痛，我通常還會進一步了解患者的：
工作、生活習慣、站姿坐姿、體態、動作模式等，再依照每個人的狀況，提供適合的衛教與動作訓練。
有些患者需要更完整、持續的運動指導；我也會轉介到自己信任的物理治療所，帶著患者進行動作及功能訓練。
最近，美國醫學會旗下的頂尖醫學期刊JAMA，刊登了一篇關於下背痛的綜論文章（Review）。文章所提出的治療方向，也和我平常的臨床觀念相當接近。
對於【急性非特異性下背痛】，可採用的第一線非藥物治療包括：
針灸、脊椎徒手治療、熱敷、按摩
必要時，也可考慮使用非類固醇消炎止痛藥（NSAIDs）或骨骼肌鬆弛劑。
至於【慢性非特異性下背痛】，通常較不容易單靠休息自行完全緩解，治療上更著重於：
• 運動與功能訓練
• 心理治療，例如認知行為治療
• 跨專業、多面向的整合治療
非類固醇消炎止痛藥則是第二線治療選項。
下背痛的治療，通常不是只靠一根針、一種手法，或一顆止痛藥。
減輕疼痛只是第一步，重新找回活動能力，並降低反覆發作的機會，才是更重要的目標。
原文連結：
https://ja.ma/43AFjkE
Low back pain is defined as pain located below the costal margin and above the inferior gluteal folds, with or without leg pain and is the leading cause of years lived with worldwide, affecting people of all ages.
Approximately 1 in 4 US workers report low back pain, with mean lifetime prevalence of approximately 40% in adults. Approximately 90% of cases presenting in clinical settings are classified as nonspecific low back pain, with no identified pathoanatomical cause. Initial management emphasizes advice, education, and continued activity.
For acute nonspecific low back pain, first-line therapies include nonpharmacological treatments such as heat application, spinal manipulation, massage, and acupuncture, along with nonsteroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants.
Chronic nonspecific low back pain is less likely to resolve but is managed with exercise, psychological therapies (such as cognitive behavioral therapy), and multidisciplinary approaches, with NSAIDs considered as second-line therapy.
📝This JAMA Review summarizes the epidemiology, pathophysiology, clinical evaluation, prognosis, and treatment of nonspecific low back pain in the outpatient setting.
https://ja.ma/43AFjkE
