La enfermedad degenerativa de la columna lumbar (ICD-11 FA80.8 / ICD-10 M51.3) es una causa frecuente de dolor lumbar tanto agudo como crónico. El manejo de primera línea es conservador, siguiendo un enfoque escalonado y estructurado para aliviar el dolor y restaurar la función.
La estrategia inicial es conservadora e incluye terapia analgésica oral guiada por un marco escalonado reconocido, combinada con intervenciones físicas activas — el régimen completo, los criterios y la secuencia se detallan en el protocolo estructurado.
The first line of treatment is certainly conservative.
In practice, this generally means the prescription of oral analgesics according to the stepwise approach of the WHO (the "analgesic ladder").
It was concluded in two Cochrane reviews that non-steroidal anti-inflammatory drugs (NSAIDs) alleviate both acute and chronic back pain.
Deyo et al. also concluded that opioids alleviate chronic back pain over the short term, but no studies are available on opioid administration for longer than four months.
Physical therapy for acute back pain was classified as ineffective by Karlsson et al. in a systematic review, while active exercise programs are recommended in multiple guidelines for the treatment of chronic low back pain.
Coulter et al. found a moderate degree of evidence favoring manual therapy over active exercise programs for the treatment of chronic back pain: in an inverse Revman model, the standardized mean difference was –0.43, with high heterogeneity ([–0.86 to 0.00]; p = 0.05, I² = 79%).
View source ↗