Alaselkäkivun tutkiminen ja hoito perusterveydenhuollossa

Abstract

• Alaselkäkipu on erittäin tavallinen vaiva, mutta hyvin harvoin taustalla on vakava syy. • Uusiutumistaipumus on vahva ja monet psykososiaaliset tekijät lisäävät alaselkäkivun pitkittymisen riskiä. Lääkärin rohkaiseva ja pelkoa vähentävä kommunikaatio on tärkeää. • Yksilölliset biopsykososiaaliset tekijät huomioiva lääkkeetön hoito on ensisijainen. Sairauslomien tulee olla lyhyitä. • Potilas on syytä ohjata herkästi fysioterapeutin arvioon.

Low back pain (LBP) and the resulting functional limitations have become a major health and socioeconomic problem causing individual suffering and costs to society. A specific cause can be found only for a small percentage of LBP patients, whilst over 90% are classified as having non-specific LBP. Lumbar degenerative changes are frequently found in asymptomatic populations, which should be explained to the patients in order to reduce worry related to reporting of imaging findings. Unnecessary imaging studies should be avoided. Serious causes of LBP are rare. Many psychosocial factors such as subjective beliefs about long-lasting pain, low pain self-efficacy (confidence in one’s own ability to get on with life despite pain), passive coping strategies, high catastrophizing and fear avoidance beliefs, depression, sleep problems, psychological distress, low education and social class and unemployment are predictors of a slower recovery. Patients with LBP who visit a general practitioner wish to have answers to the following questions: Do I have a serious condition? What is the reason for my pain? What can be done and what can I do myself? What is the prognosis of the condition? It is important to answer these questions using dethreatening and validating language to decrease anxiety and worry, and to increase feelings of safety in patients. In non-specific LBP the most important goals for an appointment are to rule out serious causes of LBP, decrease fear, increase patients’ activity and screen for psychosocial factors. Screening tools have been developed to assess functional ability and to screen for patients who have a higher risk of chronicity. Non-pharmacological treatments are the first treatment line for LBP, therapeutic exercise being one of the most important. Consultation of a physiotherapist should be arranged readily and is needed if the patient has functional limitations, fear avoidance behaviour or mal-adaptive movement strategies. Absence from work should be short, only a few days if needed. The treatment of LBP should be individualised in view of the biopsychosocial nature of LBP. Occupational health care plays an important role in rehabilitation of employees.