Ibuprofen

参考文献Gao B, Chai R, Wang G, et al.; Chinese Society for the Study of the Lumbar Spine, Chinese Association of Spine. Multidisciplinary expert consensus on clinical diagnosis and therapies for low back pain[J]. Bone Research, 2026, 14: 92. https://doi.org/10.1038/s41413‑026‑00572‑y1. 定义腰痛是常见肌肉骨骼症状，可累及腰椎区域肌肉、韧带、骨骼及相关神经结构；解剖边界：第 12 肋下缘至臀皱襞上方，可伴或不伴腿痛。腰痛是症状描述，不是单一疾病诊断；临床评估需要结合病程、体格检查、红旗征，判断是否存在明确器质性病因。2. 按病程分类急性腰痛：＜6 周亚急性腰痛：6‑12 周慢性腰痛：＞12 周（＞3 个月）；本共识所有 “慢性腰痛、慢性非特异性腰痛” 均以此为阈值。3. 按生理系统分类非特异性腰痛 NSLBP：占全部腰痛约 95%，多数病因不明；X 线、CT 常无特异性阳性发现；又可细分为小关节源性、椎间盘源性、不稳相关、骶髂关节源性、姿势相关等亚型。4. 按疼痛来源病理生理分类1）机械性疼痛：临床最常见。疼痛与体位变化、负重、腰椎活动密切相关；弯腰、久站久坐负重加重，休息调整姿势明显缓解；多和脊柱及周围软组织生物力学、结构异常相关；常见于椎间盘退变、小关节功能紊乱、腰肌劳损、骶髂关节不稳，大多归属于非特异性腰痛。 2）非机械性疼痛：疼痛和腰椎活动无典型关联；部分患者活动后症状无变化，静息时疼痛更突出；常伴随全身症状，需要高度怀疑特异性病因（炎症、感染、肿瘤、代谢病）；例如强直性脊柱炎炎性腰背痛（晨僵明显，活动后短暂缓解）；脊柱肿瘤、感染导致夜间痛、静息痛。需要结合炎症标志物、影像学进一步排查。 3）牵涉痛：腰部不适，但原发病变不在脊柱，由盆腔、腹腔脏器病变通过神经反射投射至腰部；例如泌尿系结石、盆腔炎、胰腺疾病。特点：无明确腰椎局部压痛点，疼痛与腰椎力学活动无关，伴随原发病脏器症状。 4）神经根性腰痛：神经根受压导致，疼痛沿神经放射至腿部，常伴随麻木、刺痛、肌力下降；见于腰椎间盘突出、腰椎管狭窄。 5）其他特殊病因腰痛：骨折、感染、肿瘤、炎性脊柱疾病，占比少；临床需要识别红旗征，完善检查鉴别。（一）保守治疗：首选一线核心策略适用于排除严重器质性病变之后的急、亚急性腰痛及大量慢性非特异性腰痛。完成短期治疗后复评疼痛、功能、依从性；若症状不改善、加重、出现红旗征，则升级至介入或专科评估。认知功能疗法 CFT推荐：强推荐，用于部分慢性非特异性腰痛患者，尤其存在适应不良疼痛信念、恐惧回避行为、活动回避、保护性运动模式、持续功能障碍、生活方式相关或其他心理社会康复障碍人群。（证据等级 Ⅰ，Grade A） 翻译：认知功能疗法（CFT）为以理疗师主导的个体化生物‑心理‑社会康复手段，整合疼痛教育、认知矫正、暴露训练、功能再训练、分级活动与生活方式指导。适合由训练有素临床人员规范实施。疼痛神经科学教育 PNE推荐：强推荐，作为多模式康复一部分，用于慢性非特异性腰痛，尤其疼痛灾难化、恐惧回避、中枢敏化、自我效能低下患者。（证据等级 Ⅰ，Grade A） 翻译：疼痛神经科学教育解释疼痛神经生物学，帮助患者重新理解疼痛，而不把疼痛等同于组织损伤；联合运动 / 理疗可短期改善疼痛和残疾。自我同情疗法 SCT推荐：弱推荐，作为辅助心理干预，用于自我批判应对模式、情绪困扰、疼痛灾难化、运动恐惧、自我效能差的慢性腰痛。（证据等级 Ⅰ，Grade B）理疗师主导的接纳承诺疗法 PACT推荐：弱推荐，辅助康复手段，适合心理僵化、活动回避、疼痛灾难化、持续功能障碍的慢性腰痛。（证据等级 Ⅱ，Grade B）动机性访谈 MI推荐：弱推荐，纳入多模式治疗；用于慢性非特异性腰痛；对亚急性腰痛相比标准护理获益尚不明确。（证据等级 Ⅱ，Grade C）正念冥想推荐：弱推荐，身心干预手段，用于疼痛干扰生活、心理困扰、睡眠差、阿片类药物难治慢性腰痛。（证据等级 Ⅰ/Ⅱ，Grade B）核心稳定 / 运动控制训练推荐：弱推荐，用于运动控制受损、躯干肌肉激活差、腰椎稳定性下降、持续功能障碍慢性非特异性腰痛。（证据等级 Ⅰ/Ⅱ，Grade B）悬吊训练 Sling exercise推荐：弱推荐，用于躯干控制受损、核心稳定性差、可疑腰椎不稳慢性腰痛。（证据等级 Ⅰ/Ⅱ，Grade B）本体感觉神经肌肉促进技术 PNF推荐：弱推荐，用于躯干本体感觉受损、神经肌肉协调差、平衡障碍、功能受限慢性腰痛。（证据等级 Ⅰ，Grade B）麦肯基疗法 McKenzie推荐：强推荐，个体化运动康复；适合力学评估存在方向偏好、疼痛中心化现象的慢性腰痛。（证据等级 Ⅰ，Grade A）低负荷血流限制训练 LL‑BFRT推荐：弱推荐，辅助力量训练；不能耐受大负荷抗阻训练、核心肌力耐力不足慢性腰痛。（证据等级 Ⅱ，Grade B）水中运动推荐：强推荐，主动康复手段；尤其陆地运动难以耐受慢性腰痛患者。（证据等级 Ⅰ，Grade A）普拉提 Pilates推荐：弱推荐，身心运动康复；躯干控制受损、核心耐力不足、运动恐惧慢性非特异性腰痛。（证据等级 Ⅰ，Grade B）八段锦 / 气功 Baduanjin or Qigong推荐：强推荐，低强度身心运动；居家锻炼、体能差、依从性差、心理压力大、不耐受常规运动慢性非特异性腰痛。（证据等级 Ⅰ，Grade B）太极拳 Tai Chi推荐：强推荐，非药物运动；适合慢性非特异性腰痛，优选受过规范指导人群。（证据等级 Ⅰ，Grade A）瑜伽 Yoga推荐：弱推荐，身心运动，注意避免过度腰椎屈伸负重。（证据等级 Ⅰ，Grade B）沃伊塔疗法 Vojta therapy推荐：弱推荐，神经运动康复；显著功能受限、躯干姿势控制受损慢性腰痛，作为多模式一部分。（证据等级 Ⅱ，Grade B）费登奎斯 Feldenkrais推荐：弱推荐，运动再教育康复；身体觉知差、明显功能受限慢性腰痛。（证据等级 Ⅱ，Grade B）结缔组织按摩 CTM推荐：弱推荐，软组织徒手辅助治疗；腰椎活动受限、主观健康感受下降慢性腰痛。（证据等级 Ⅱ，Grade B）脊柱手法治疗 Spinal manipulative therapy推荐：弱推荐，辅助徒手治疗，建议和运动疗法联合使用，不作为单一治疗。（证据等级 Ⅰ，Grade B）内脏手法松解 VM推荐：弱推荐，辅助徒手治疗，用于合并内脏功能障碍部分筛选患者。（证据等级 Ⅱ，Grade B）肌筋膜释放 Myofascial release推荐：弱推荐，辅助软组织治疗；明显肌肉筋膜紧张、功能受限患者，不能作为根治性核心手段。（证据等级 Ⅰ，Grade C）推拿 Tuina推荐：弱推荐，传统徒手康复；不能立刻开展主动运动慢性非特异性腰痛，建议结合教育、自我管理。（证据等级 Ⅰ，Grade C）器械辅助软组织松解 IASTM推荐：弱推荐，仅作为辅助手段，不做单独核心治疗。（证据等级 Ⅰ/Ⅱ，Grade C）艾灸 Moxibustion推荐：弱推荐，温热类中医辅助疗法，纳入多模式综合方案。（证据等级 Ⅰ，Grade B）针灸 Acupuncture推荐：强推荐，一线非药物治疗，慢性非特异性腰痛。（证据等级 Ⅰ，Grade A）干针 Dry needling推荐：弱推荐，辅助干预；存在明确肌筋膜触发点慢性腰痛。（证据等级 Ⅰ，Grade C）经皮神经电刺激 TENS推荐：弱推荐；短期试用作为康复辅助；无获益则停用。（证据等级 Ⅰ，Grade B）经颅直流电刺激 tDCS推荐：弱推荐，神经调控辅助；优先联合结构化运动训练。（证据等级 Ⅰ/Ⅱ，Grade B）周围神经刺激 PNS推荐：弱推荐，神经调控；常规保守治疗失败的难治慢性腰痛。（证据等级 Ⅱ，Grade C）椎间盘内富血小板血浆 PRP 注射推荐：弱推荐；严格筛选保守治疗失败椎间盘源性慢性腰痛。优先影像引导、标准化制备。（证据等级 Ⅰ，Grade B）椎间盘间充质干细胞注射推荐：弱推荐，仅限伦理审批注册临床研究条件下使用；筛选椎间盘源性腰痛，同时评估椎间盘‑终板单元状态。（证据等级 Ⅰ，Grade C）药物治疗口服非甾体抗炎药 NSAIDs推荐：强推荐，急性腰痛需要药物干预患者；使用最低有效剂量，最短疗程，评估胃肠道、心血管、肾脏风险。（证据等级 Ⅰ，Grade A）布洛芬 + 对乙酰氨基酚复方制剂推荐：弱推荐；急性腰痛短期对症，单药效果不佳筛选人群。（证据等级 Ⅰ，Grade B）阿片类药物强烈不推荐用于腰痛常规管理；仅 NSAIDs 禁忌或无效的急性重度疼痛，短期小剂量救援性使用。（证据等级 Ⅰ，Grade A）肌肉松弛剂推荐：弱推荐；急性非神经根性腰痛伴肌肉痉挛，短期疗程，警惕镇静跌倒风险。（证据等级 Ⅰ，Grade B）5‑羟色胺‑去甲肾上腺素再摄取抑制剂 SNRIs（如度洛西汀）推荐：弱推荐；慢性非特异性腰痛合并情绪、睡眠、中枢敏化疼痛人群。不作为一线，不替代运动心理干预。（证据等级 Ⅰ，Grade B）生物制剂（抗 TNF‑α、抗 NGF 单抗）强烈不推荐普通慢性腰痛常规使用；获益有限，风险‑收益比差。（证据等级 Ⅰ，Grade C）术前预康复 prehabilitation推荐：弱推荐，择期腰椎手术高危恢复不良患者的术前优化策略。（证据等级 Ⅰ，Grade C）个体化顺势疗法强烈不推荐常规腰痛管理，仅可用于设计严谨的临床试验。（证据等级 Ⅰ，Grade C）（二）介入治疗经椎间孔硬膜外类固醇注射 TFESI推荐：弱推荐；筛选急性重度坐骨神经痛患者，主要短期缓解根性疼痛。不做全部坐骨神经痛常规使用。（证据等级 Ⅰ/Ⅱ，Grade B）小关节内侧支射频消融推荐：弱推荐；经诊断阻滞确认小关节源性慢性腰痛，可实现持续疼痛缓解，改善功能残疾。（证据等级 Ⅰ，Grade B）影像引导骶髂关节注射推荐：弱推荐；确诊骶髂关节源性腰痛，保守治疗无效筛选患者。（证据等级 Ⅰ，Grade C）触发点注射 TPI推荐：弱推荐；肌筋膜触发点相关急性腰痛。（证据等级 Ⅰ，Grade B）椎间盘内糖皮质激素注射 IGI推荐：弱推荐；存在活动性椎间盘病变、Modic 改变的椎间盘源性慢性腰痛，短期过渡止痛，中长期疗效有限。（证据等级 Ⅰ，Grade B）臭氧注射推荐：弱推荐，辅助选项；腰椎间盘突出根性腰腿痛，保守失败筛选患者，疗效持续时间有限。（证据等级 Ⅰ/Ⅱ，Grade C）经皮椎间盘内射频热凝 PIRFT不推荐常规用于非特异性或普通椎间盘源性腰痛；仅严格筛选保守失败患者，仅限研究、审计严格管控条件下使用。（证据等级 Ⅰ，Grade C）椎间盘内热疗 IDET不推荐常规使用；仅高度筛选患者，研究管控条件。（证据等级 Ⅰ，Grade C）等离子椎间盘减压 PDD推荐：弱推荐；包容性椎间盘突出根性痛，保守失败，开放手术不合适筛选患者。（证据等级 Ⅰ，Grade C）脊髓电刺激 SCS推荐：弱推荐；难治慢性腰腿痛、腰椎术后失败综合征、神经病理性根性疼痛，必须先成功测试刺激。（证据等级 Ⅰ，Grade A）脉冲射频 PRF推荐：弱推荐；保守 / 硬膜外注射无效难治腰椎根性坐骨神经痛。（证据等级 Ⅰ，Grade B）背根神经节刺激 DRGS推荐：弱推荐；难治神经病理性腰腿痛，术后失败综合征、CRPS，测试刺激有效筛选患者。（证据等级 Ⅰ/Ⅱ，Grade C）周围神经场刺激 PNFS推荐：弱推荐；术后持续性轴性腰痛，测试刺激有效筛选患者。（证据等级 Ⅰ，Grade C）（三）外科手术治疗内镜下椎间盘切除术 ED推荐：弱推荐；腰椎间盘突出根性腰腿痛，保守治疗失败筛选患者，由经验丰富外科医师实施。（证据等级 Ⅰ，Grade B）人工椎间盘置换 TDR推荐：弱推荐；保守治疗失败椎间盘源性慢性腰痛，严格筛选，排除禁忌。（证据等级 Ⅰ/Ⅱ，Grade B）腰椎椎管减压术推荐：弱推荐；腰椎管狭窄导致神经源性跛行或坐骨神经痛，保守治疗无效筛选患者，充分医患共同决策。（证据等级 Ⅰ，Grade B）腰椎椎间融合 LIF推荐：弱推荐；慢性椎间盘源性腰痛、退变性滑脱、脊柱不稳、复发性椎间盘突出伴不稳、畸形、假关节形成；症状与影像学匹配筛选患者。不做减压手术的常规附加。（证据等级 Ⅰ，Grade B）骶髂关节融合术推荐：弱推荐；确认骶髂关节源性疼痛，保守治疗无效，尤其退变性骶髂关节炎、腰椎术后继发骶髂疼痛；不用于未证实来源非特异性腰痛。（证据等级 Ⅰ，Grade B）（四）综合干预：多模式整合、个体化长期管理多学科生物‑心理‑社会模式康复强推荐；持续慢性腰痛，心理社会障碍、功能残疾高、既往单一治疗应答差；复杂致残病例优先高强度功能恢复项目。（证据等级 Ⅰ，Grade A）规范理疗联合结构化患者教育强推荐；持续 / 复发性慢性腰痛，自我管理差、恐惧回避、慢性化高危人群。（证据等级 Ⅰ，Grade A）理疗师实施的认知行为干预强推荐；存在心理社会障碍、恐惧回避、灾难化思维、自我效能低下、康复不良高危慢性腰痛。（证据等级 Ⅰ，Grade A）团体运动 + 健康教育干预强推荐；慢性复发性腰痛，希望提升自我管理、运动信心、功能恢复患者。（证据等级 Ⅰ，Grade A）风险分层 + 共同临床决策弱推荐；病程长、反复发作、治疗选择复杂腰痛。（证据等级 Ⅰ，Grade B）风险分层定制化照护弱推荐；使用 STarT Back 等工具分层，低风险给予安慰与自我管理，中风险理疗，高风险心理导向强化干预。（证据等级 Ⅰ，Grade B）Back school 腰痛学校弱推荐，团体教育运动辅助手段；慢性复发性非特异性腰痛，尤其职业场景，不能作为独立根治手段。（证据等级 Ⅰ，Grade B）数字化自我管理支持干预弱推荐；居家康复、长期随访、依从性差患者。（证据等级 Ⅰ，Grade B）分层混合模式理疗（线上 + 线下结合）弱推荐；无法频繁门诊，需要长期管理腰痛患者。（证据等级 Ⅰ，Grade B）工作场所干预（工效学）弱推荐；职业相关腰痛，复工、病假风险工人，结合临床照护与工作调整。（证据等级 Ⅰ，Grade B）AI 辅助远程康复数字疗法弱推荐；居家运动指导、实时运动反馈需求的慢性非特异性腰痛，知晓当前证据局限性。（证据等级 Ⅰ，Grade B）可穿戴设备联合常规理疗弱推荐；活动不足、运动依从性差；更多用于行为改变监测，不直接强效止痛。（证据等级 Ⅰ，Grade 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ROSEMONT, Ill., Oct. 20, 2026 /PRNewswire/ -- Over 3 million people have been diagnosed with hidradenitis suppurativa (HS) in the United States and today, the American Academy of Dermatology (AAD) and the Hidradenitis Suppurativa Foundation (HSF) have published the first-ever joint guidelines for the management and care of HS. HS is a skin condition that causes painful lumps deep in the skin, typically in areas of the body where skin rubs together like armpits, inner thighs, and the groin. Early diagnosis of HS is critical as it is often confused with acne or infection, causing people to go years without an accurate diagnosis. A board-certified dermatologist can both identify HS and screen for the medical and psychiatric conditions that often accompany it, giving patients access to comprehensive, individualized care sooner. "While hidradenitis suppurativa is a chronic condition, its painful symptoms are highly treatable," said AAD President and board-certified dermatologist Murad Alam, MD, MSCI, MBA, FAAD. "For millions of people with HS, dermatologists provide more than just a diagnosis. They provide expert, comprehensive care that allows patients to have a better quality of life." Compiled by a work group of 13 experts, including 12 board-certified dermatologists, the newly released guidelines, published in the Journal of the American Academy of Dermatology (JAAD), include 37 evidence-based recommendations designed to treat chronic HS disease and acute HS flares. "These guidelines establish an evidence-based standard of care for HS, giving patients, dermatologists, and payers a shared roadmap for what high-quality HS care looks like," said board-certified dermatologist Haley B. Naik, MD, FAAD, co-chair of the Hidradenitis Suppurativa Guideline Work Group and president of HSF. "Every person living with HS deserves care that meets this standard." The largest barrier to impactful HS care is step therapy, an insurance requirement for patients to try insurer-designated treatments before coverage is approved for the dermatologist-prescribed preferred medication. Evidence does not support the use of step therapy in HS care as it delays access to appropriate treatment. Strong recommendations of care Strong recommendations imply that treatment benefits clearly outweigh risks and burdens. These recommendations apply to most patients in most circumstances. Biologics (adalimumab, bimekizumab, infliximab, and secukinumab), injectable treatments that target the immune system, are strongly recommended for individuals with moderate-to-severe HS. These treatments are shown to reduce the number of abscesses and nodules by at least half, without any new abscess or tunnel development. Abscesses are painful lumps that grow, join together, and fill with fluid. Tunnels are hollow channels that form under the skin. Conditional recommendations of care Conditional recommendations imply that treatment benefits are closely balanced with risks and burdens. These recommendations apply to most patients, but the best course depends on what matters most to each individual, including their tolerance for side effects, treatment goals, and day-to-day circumstances. Topical therapies (clindamycin, resorcinol, and ruxolitinib) are applied to the skin to reduce abscesses and the severity of symptoms. Systemic antibiotics (doxycycline, tetracycline, clindamycin in combination with rifampin, and ertapenem) work throughout the body to decrease severity of symptoms and improve quality of life. Hormone therapy (spironolactone) is taken by mouth to decrease severity. Systemic therapies (upadacitinib and short-term systemic steroids) are taken by mouth and work throughout the body for individuals with moderate-to-severe HS to reduce disease activity and pain. Continuing injectable biologics (adalimumab) is recommended for individuals with moderate-to-severe HS undergoing surgery. In-office procedures can be especially helpful if abscesses and tunnels have formed in the skin, including: Deroofing, a minor treatment to open and flatten the tunnels under the skin. This treats recurrent or persistently bothersome HS lesions, or bumps, spots, or growths. Incision and drainage to treat painful abscesses. Surgical removal of an area of affected skin for abscesses or tunnels that persist or continue to come back. Laser hair removal for fewer flares. Botulinum toxin to reduce flares. Intralesional triamcinolone (a steroid injection) to treat painful, flaring bumps. Conditional recommendations were made against the use of oral retinoids (acitretin and isotretinoin), certain biologics (etanercept, guselkumab, risankizumab, and vilobelimab), systemic therapies (avacopan, and methotrexate and azathioprine as primary treatments), and radiotherapy for pediatric and adolescent HS patients. In addition, there is insufficient evidence to support oral contraceptive pills or finasteride (hair loss medication) for HS management. Supportive management While HS therapies may reduce pain, they don't always achieve adequate pain relief. Supportive pain management is a conditional recommendation that helps manage sudden pain, consistent pain, and pain that does not improve after treatment and pain relief therapies. Treatments to manage sudden pain include warm or cool compresses, topical lidocaine (a local anesthetic), acetaminophen (a pain reliever), nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen, steroid injections, incision and drainage, and short-term steroids that work throughout the body. Opioids can be used if the pain doesn't decrease through other treatments. Long-lasting pain can be managed with serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, psychotherapy, proper wound care, and nerve pain medications such as gabapentin and pregabalin. There is insufficient evidence to support weight reduction and GLP-1 usage for HS treatment. There is also insufficient evidence that specific diet plans — intermittent fasting, the Mediterranean diet, the yeast exclusion diet, and the dairy-free diet — help manage HS. However, a heart-healthy diet of fruits and vegetables, whole grains, healthy fats, and lean proteins remains important for reducing heart and diabetes risk for individuals with HS. Complementary medicine Lifestyle changes and supplements can also help manage the pain and discomfort from HS. A conditional recommendation was made for quitting tobacco, which can improve an individual's response to treatments aimed at addressing the disease itself. Conditional recommendations were made for complementary and alternative medicine, including vitamin D supplements for individuals with deficiencies, and zinc supplements. These supplements, taken under a doctor's supervision, may reduce lumps and tunnels and relieve pain. "Untreated HS can have a serious impact on your health and well-being. It can cause scarring, wounds that limit your mobility, and intense pain. It also often happens in combination with other medical and psychiatric conditions, with this increasing its overall toll on patients," said Dr. Alam. "Whether you've been diagnosed with HS or suspect you may have it, please take the time to see a board-certified dermatologist to have it expertly assessed, consider your options, and find the best plan for you." To find a board-certified dermatologist in your area, visit aad.org/findaderm. Resources Hidradenitis Suppurativa: Overview (AAD) How to Treat HS (HSF) Find an HS Provider (HSF) About the AAD Headquartered in Rosemont, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential and most representative of all dermatologic associations. With a membership of more than 21,500 physicians worldwide, the AAD is committed to advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair, and nails; advocating high standards in clinical practice, education and research in dermatology; and supporting and enhancing patient care because skin, hair, and nail conditions can have a serious impact on your health and well-being. For more information, contact the AAD at (888) 462-DERM (3376) or aad.org. Follow @AADskin on Facebook, TikTok, Pinterest, and YouTube, and @AADskin1 on Instagram. About the Hidradenitis Suppurativa Foundation Since its founding in 2005, the Hidradenitis Suppurativa Foundation has fostered and encouraged worldwide research by developing and supporting an interdisciplinary family of scientists and physicians devoted to studying Hidradenitis Suppurativa, in order to deliver more effective forms of treatment and preventative measures to those with this common, debilitating, and eminently chronic disease. HSF is a 501(c)(3) dedicated to improving the lives of people affected by Hidradenitis Suppurativa (HS) through research, education, and advocacy. Explore their resources for patients, clinicians, and investigators at hs-foundation.org, and follow @hsforg on Instagram and YouTube, and @HidradenitisSuppurativaFoundation on Facebook and LinkedIn. SOURCE American Academy of Dermatology 21% more press release views with Request a Demo