La maladie dégénérative du rachis lombaire (ICD-11 FA80.8 / ICD-10 M51.3) est une cause fréquente de lombalgie aiguë et chronique. La prise en charge de première intention est conservatrice, selon une approche structurée par étapes visant à soulager la douleur et à restaurer la fonction.
La stratégie initiale est conservatrice et comprend une thérapie analgésique orale guidée par un cadre progressif reconnu, associée à des interventions physiques actives — le protocole complet, les critères et le séquençage sont détaillés dans le protocole structuré.
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%).
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