laendesmerter-lave-rygsmerter (LH Indholdsside)

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    <Content>
      <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2>
<h3>Diagnostiske kriterier</h3>
<ul>
    <li>Klinisk diagnose baseret p&aring; sygehistorie og kliniske fund</li>
    <li>Form&aring;let med den kliniske unders&oslash;gelse er at identificere patienter, som kr&aelig;ver umiddelbar kirurgisk vurdering, og de tilf&aelig;lde som skyldes en alvorlig, underliggende sygdom som malignitet, infektion eller cauda equina syndrom</li>
</ul>
<h4>Hoveddiagnosegrupper</h4>
<ul>
    <li>Uspecifikke l&aelig;nderygsmerter -&nbsp;<strong>gr&oslash;nne flag</strong>
    <ul>
        <li>Smerteudbredelse l&aelig;nderyg, nates og l&aring;r</li>
        <li>Smerteintensitet varierer, ofte bedre i ro</li>
        <li>God almentilstand</li>
        <li>God prognose indikeret ved gr&oslash;nne flag og frav&aelig;r af r&oslash;de og gule flag</li>
    </ul>
    </li>
    <li>Nerverodsaffektion -&nbsp;<strong>gule flag</strong>
    <ul>
        <li>Udstr&aring;lende smerter er ofte mere distinkte og svarende til et eller flere dermatomer</li>
        <li>F&oslash;lelsesl&oslash;shed og par&aelig;stesier i varierende grad</li>
        <li>Lasegues pr&oslash;ve reproducerer smerteudstr&aring;lingen</li>
        <li>Motoriske, sensoriske og/eller refleksforandringer svarende til en eller flere nerver&oslash;dder</li>
        <li>Hosten/nysen reproducerer smerteudstr&aring;lingen</li>
        <li>Neurogen claudicatio/spinal stenose - se kliniske fund</li>
    </ul>
    </li>
    <li>Mulig alvorlig underliggende sygdom, evt. cauda equina -&nbsp;<strong>r&oslash;de flag</strong>
    <ul>
        <li>Tidligere kr&aelig;ftsygdom</li>
        <li>Ryggener som debuterer, eller opfattes anderledes end tidligere gener</li>
        <li>Konstante smerter, evt. tiltagende over tid, hvilesmerter</li>
        <li>Generel sygdomsf&oslash;lelse, feber og/eller v&aelig;gttab</li>
        <li>Traume,&nbsp;<a href="~/link.aspx?_id=00548CAFEC844B9E8FC871B60BAA152B&amp;_z=z">osteoporos</a>e, brug af steroider eller immunosuppressiva, stofmisbrug</li>
        <li>Udbredte og evt. progredierende neurologiske udfald</li>
        <li>Deformitet i rygs&oslash;jlen</li>
        <li>H&oslash;j SR, udtalt morgenstivhed med varighed over en time</li>
    </ul>
    </li>
</ul>
<h4>Gule flag</h4>
<ul>
    <li>Patienter med nerverodsaffektion eller omfattende tidligere ryggener</li>
    <li>Risikofaktorer, hovedsageligt psykosociale, for at udvikle mere langvarige ryggener</li>
    <li>Arbejdsrelaterede problemer/sygemelding (b&oslash;r tidsbegr&aelig;nses)</li>
    <li>Emotionelle problemer (fx depression og angst)</li>
    <li>Till&aelig;gssymptomer i form af generaliserede smerter, hovedpine, tr&aelig;thed, svimmelhed og gener fra maven</li>
</ul>
<h4>R&oslash;de flag</h4>
<ul>
    <li>Patienten udredes med tanke p&aring; mulig underliggende sygdom:
    <ul>
        <li>Deformitet, brud, inflammatorisk sygdom, tumor/metastaser, infektion,&nbsp;referred&nbsp;smerte fra indre organer, eller andre sj&aelig;ldne tilstande</li>
    </ul>
    </li>
    <li>Der er lav specificitet og sensitivitet ved anvendelse af r&oslash;de flag til at identificere patienter med alvorlig l&aelig;ndepatologi (cancer, fraktur, infektion, bindev&aelig;vssygdom)<a href="EditorPage.aspx?da=core&amp;id=%7B74E03C59-1999-40A0-B4E1-88E5C2758423%7D&amp;ed=FIELD11821317523&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H11821317718&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Premkumar A, Godfrey W, Gottschalk MB, Boden SD, Red Flags for Low Back Pain Are Not Always Really Red: A Prospective Evaluation of the Clinical Utility of Commonly Used Screening Questions for Low Back Pain. J Bone Joint Surg Am 2018;100: 368-374" data-value-piped="Premkumar A, Godfrey W, Gottschalk MB, Boden SD|Red Flags for Low Back Pain Are Not Always Really Red: A Prospective Evaluation of the Clinical Utility of Commonly Used Screening Questions for Low Back Pain.|J Bone Joint Surg Am|2018|100|368-374|29509613" data-url="reference-link" data-pubmedid="29509613" title="Premkumar A, Godfrey W, Gottschalk MB, Boden SD, Red Flags for Low Back Pain Are Not Always Really Red: A Prospective Evaluation of the Clinical Utility of Commonly Used Screening Questions for Low Back Pain. J Bone Joint Surg Am 2018;100: 368-374"><sup>1</sup></a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B74E03C59-1999-40A0-B4E1-88E5C2758423%7D&amp;ed=FIELD11821317523&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H11821317718&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Tsiang JT, Kinzy TG, Thompson N, Tanenbaum JE, Thakore NL, Khalaf T, Katzan IL, Sensitivity and Specificity of Patient-Entered Red Flags for Lower Back Pain. Spine J 2018;: " data-value-piped="Tsiang JT, Kinzy TG, Thompson N, Tanenbaum JE, Thakore NL, Khalaf T, Katzan IL|Sensitivity and Specificity of Patient-Entered Red Flags for Lower Back Pain.|Spine J|2018|||29959102" data-url="reference-link" data-pubmedid="29959102" title="Tsiang JT, Kinzy TG, Thompson N, Tanenbaum JE, Thakore NL, Khalaf T, Katzan IL, Sensitivity and Specificity of Patient-Entered Red Flags for Lower Back Pain. Spine J 2018;: "><sup>2</sup></a></li>
</ul>
<h3>Sygehistorie</h3>
<h4>Anamnestiske sp&oslash;rgsm&aring;l</h4>
<ul>
    <li>Tilpasses den enkelte patient</li>
    <li>Smertens varighed?</li>
    <li>Hvordan arter smerten sig?</li>
    <li>Hvor intens er smerten?</li>
    <li>Lokalisation af smerterne?</li>
    <li>Tidligere rygepisoder?</li>
    <li>Type smertebehandling?</li>
    <li>Mestring og funktion?</li>
    <li>Sygdomsoplevelse?</li>
    <li>Smerteundg&aring;else?</li>
    <li>Tanker og pr&aelig;ferencer om tiltag?</li>
    <li>Andre sygdomme og gener?</li>
</ul>
<h4>Akutte rygsmerter</h4>
<ul>
    <li>Pludseligt opst&aring;ede rygsmerter, som regel efter l&oslash;ft og/eller rotation af ryggen</li>
    <li>Lokalisation i nedre del af ryggen</li>
    <li>Evt. udstr&aring;ling til balden og kn&aelig;et, men ikke l&aelig;ngere distalt</li>
</ul>
<h4>Langvarige rygsmerter</h4>
<ul>
    <li>Daglige smerter over lang tid er en stor belastning, som ber&oslash;rer mange sider af livet</li>
    <li>Hyppige till&aelig;gsgener er s&oslash;vnbesv&aelig;r, hum&oslash;rforandringer, depression, nedslidthed</li>
    <li>Oftest opst&aring;et uden kendt &aring;rsag</li>
    <li>Vurder alvorlighedsgrad ud fra
    <ul>
        <li>Grad af funktionstab</li>
        <li>Progredierende smerter</li>
        <li>V&aelig;gttab</li>
    </ul>
    </li>
</ul>
<h3>Kliniske fund</h3>
<h4>Systematisk klinisk unders&oslash;gelse</h4>
<ul>
    <li>Inspektion
    <ul>
        <li>Gang, af- og p&aring;kl&aelig;dning, kropssprog, kropsholdning, smerteadf&aelig;rd</li>
        <li>Deformitet eller skoliose</li>
    </ul>
    </li>
    <li>Bev&aelig;gelighed
    <ul>
        <li>Lateralfleksion</li>
        <li>Fremad- og bagoverb&oslash;jning</li>
        <li>Afstand finger-gulv</li>
        <li>Modificeret Schober index giver mere specifik oplysning om ryggens mobilitet
        <ul>
            <li>Tegn en vandret linje mellem de to spina iliaca post sup</li>
            <li>Tegn en vandret linje 10 cm over den f&oslash;rste vandrette linje</li>
            <li>Ved foroverb&oslash;jning skal denne afstand &oslash;ges til mindst 15 cm</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Lasegues pr&oslash;ve (strakt benl&oslash;ft test)
    <ul>
        <li>Udf&oslash;res ved udstr&aring;lende smerte</li>
        <li>Ved strakt benl&oslash;ft kan smerten ned i benet reproduceres</li>
        <li>Gradantal og smerteudstr&aring;lingens lokalisation noteres</li>
    </ul>
    </li>
    <li>Neurologisk unders&oslash;gelse
    <ul>
        <li>Ved mistanke om nerverodsaffektion</li>
        <li>St&aring; p&aring; t&aelig;er (S1)</li>
        <li>G&aring; p&aring; h&aelig;l (L5)</li>
        <li>Sidde p&aring; hug (L4)</li>
        <li>Tjek f&oslash;lesans (<a href="~/link.aspx?_id=7C45B8ADDD0C4084B0A34A55956EB5DC&amp;_z=z">L4</a>,&nbsp;<a href="~/link.aspx?_id=98047E0608D345EBA7E9296DB04104BB&amp;_z=z">L5</a>,&nbsp;<a href="~/link.aspx?_id=AAAC9A0EA9154912995BC3A875DCCFF7&amp;_z=z">S1</a>)</li>
        <li>Reflekser</li>
    </ul>
    </li>
</ul>
<h4>Akutte rygsmerter</h4>
<ul>
    <li>Observation af patientens m&aring;de at bev&aelig;ge sig p&aring; er ofte tilstr&aelig;kkeligt for at bekr&aelig;fte diagnosen
    <ul>
        <li>S&aelig;rligt hvor det drejer sig om recidiv uden &aelig;ndring i symptomm&oslash;nster, er yderligere unders&oslash;gelser ofte un&oslash;dvendige</li>
    </ul>
    </li>
    <li>Nedsat bev&aelig;gelighed af columna</li>
    <li>Spasmer i paravertebral muskulatur</li>
    <li>Positiv Lasegue og/eller neurologiske udfald tyder p&aring; nerverodsaffektion</li>
</ul>
<h4>Langvarige rygsmerter</h4>
<ul>
    <li>Foruden lokale fund fra ryggen b&oslash;r f&oslash;lgende ogs&aring; vurderes:
    <ul>
        <li>Radikul&aelig;re udfald</li>
        <li>Tegn til andre organiske sygdomme, bl.a. prostatakr&aelig;ft og brystkr&aelig;ft</li>
        <li>Sygdomsadf&aelig;rd og evt. sekund&aelig;rgevinst</li>
    </ul>
    </li>
</ul>
<h3>Supplerende unders&oslash;gelser i almen praksis</h3>
<ul>
    <li>Er som regel ikke p&aring;kr&aelig;vet ved akutte rygsmerter</li>
    <li>Ved usikkerhed om underliggende sygdom kan pr&oslash;ver som Hb, leuko + diff, SR, CRP v&aelig;re aktuelle</li>
    <li>Ved langvarige eller recidiverende ryggener b&oslash;r HLA-B27 kontrolleres, og det b&oslash;r overvejes at tage basisk fosfatase, kalcium, fosfat, PSA</li>
</ul>
<h3>Andre unders&oslash;gelser hos specialist</h3>
<h4>Billeddiagnostik</h4>
<ul>
    <li>Er un&oslash;dvendigt ved akutte tilstande, hvis der ikke er symptomer eller fund foreneligt med alvorlig sygdom<a href="%20" title="Chou R, Fu R, Carrino JA, Deyo RA, Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet 2009;373: 463-72" data-url="reference-link" data-value-piped="Chou R, Fu R, Carrino JA, Deyo RA|Imaging strategies for low-back pain: systematic review and meta-analysis|Lancet|2009|373|463-72" data-value="Chou R, Fu R, Carrino JA, Deyo RA, Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet 2009;373: 463-72" data-type="journal-reference"><sup>3</sup></a>
    <ul>
        <li>I f&oslash;lge danske, norske og britiske nationale retningslinjer anbefales der ikke billeddiagnostik hverken ved akutte, subakutte eller langvarige l&aelig;nderygsmerter, eller initialt ved nerverodsaffektion uden r&oslash;de flag&nbsp;<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016"><sup>4</sup></a><sup>,</sup><a href="https://www.sst.dk/da/sygdom-og-behandling/kronisk-sygdom/faglige-anbefalinger/~/media/D995B05669A44B319734DD8206975B16.ashx" data-type="other-reference" data-value="Anbefalinger for tværsektorielle forløb for mennesker med kroniske lænderygsmerter, Sundhedsstyrelsen, 2017" data-url="https://www.sst.dk/da/sygdom-og-behandling/kronisk-sygdom/faglige-anbefalinger/~/media/D995B05669A44B319734DD8206975B16.ashx" title="Anbefalinger for tværsektorielle forløb for mennesker med kroniske lænderygsmerter, Sundhedsstyrelsen, 2017"><sup>5</sup></a><sup>,</sup><a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
    </ul>
    </li>
    <li>Tilbyd ikke rutinem&aelig;ssig billeddiagnostisk udredning med MR-skanning eller&nbsp;r&oslash;ntgenunders&oslash;gelse til patienter med nyopst&aring;ede l&aelig;nderygsmerter, da der ikke er p&aring;vist en gavnlig effekt<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016"><sup>4</sup></a></li>
    <li>Degenerative fund ved billeddiagnostik korrelerer d&aring;rligt med symptomer</li>
    <li>Det anbefales, at der kun henvises til yderligere billeddiagnostik (r&oslash;ntgen, CT, MR) ved mistanke om alvorlig sygdom, eller hvor billeddiagnostiske unders&oslash;gelser muligvis vil &aelig;ndre diagnosen og/eller behandlingstilbuddet (NICE 2016). Årsagerne kan fx v&aelig;re:
    <ul>
        <li>Mistanke om alvorlig rygpatologi. Ved mistanke om akut tilstand, som fx cauda equina syndrom eller cancer, hvor patienten udviser kliniske tegn på neurokompression, skal patienten straks have foretaget en rygkirurgisk/reumatologisk vurdering, idet prognosen er afh&aelig;ngig af tidsfaktoren</li>
        <li>Nytilkomne eller vedvarende smerter med udstråling til et eller begge ben, hvor der ikke er tilstr&aelig;kkeligt effekt af smertestillende medicin, manuel behandling og/eller specifikke &oslash;velser</li>
        <li>Gangbesv&aelig;r tydende på spinalstenose, hvor kirurgi overvejes</li>
        <li>Inflammatorisk gigtsygdom</li>
        <li>Betydelig skoliose</li>
        <li>Mistanke om nytilkommen sammenfald af ryghvirvler</li>
        <li>Traume</li>
    </ul>
    </li>
    <li>MR-skanning vil hos nogle patienter (op til 45 %) med kroniske rygsmerter vise de s&aring;kaldte Modic-forandringer, som repr&aelig;senterer knoglemarvsforandringer i l&aelig;nderyghvirvler uden knoglemetastaser, infektion eller sero-positiv gigtsygdom<a href="EditorPage.aspx?da=core&amp;id=%7B74E03C59-1999-40A0-B4E1-88E5C2758423%7D&amp;ed=FIELD11821317523&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H11821317718&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Dudli S, Fields AJ, Samartzis D, Karppinen J, Lotz JC, Pathobiology of Modic changes. Eur Spine J 2016;25: 3723-3734" data-value-piped="Dudli S, Fields AJ, Samartzis D, Karppinen J, Lotz JC|Pathobiology of Modic changes|Eur Spine J|2016|25|3723-3734|" data-url="reference-link" title="Dudli S, Fields AJ, Samartzis D, Karppinen J, Lotz JC, Pathobiology of Modic changes. Eur Spine J 2016;25: 3723-3734"><sup>7</sup></a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B74E03C59-1999-40A0-B4E1-88E5C2758423%7D&amp;ed=FIELD18949727981&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H18949728040&amp;us=sitecore%5Csoko&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR, Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988;166: 193-9" data-value-piped="Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR|Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging.|Radiology|1988|166|193-9|3336678" data-url="reference-link" data-pubmedid="3336678" title="Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR, Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988;166: 193-9"><sup>8</sup></a>&nbsp;
    <ul>
        <li>Der er ikke evidens for at behandle rygsmerter med antibiotika hos patienter med Modic-forandringer<a href=" " data-type="journal-reference" data-value="Udby PM, Fritzell P, Bergström T, Jönsson B, Skorpil M, Hägg O, Andersen MØ, [Antibiotics should not be used for treating back pain due to Modic changes].. Ugeskr Laeger 2020;182: " data-value-piped="Udby PM, Fritzell P, Bergström T, Jönsson B, Skorpil M, Hägg O, Andersen MØ|[Antibiotics should not be used for treating back pain due to Modic changes].|Ugeskr Laeger|2020|182||33046199" data-url="reference-link" data-pubmedid="33046199" title="Udby PM, Fritzell P, Bergström T, Jönsson B, Skorpil M, Hägg O, Andersen MØ, [Antibiotics should not be used for treating back pain due to Modic changes].. Ugeskr Laeger 2020;182: "><sup>9</sup></a></li>
        <li>Prognosen for smerter og funktionsniveau er uafh&aelig;ngig af evt. Modic forandringer<a href=" " data-type="journal-reference" data-value="Udby PM, Fritzell P, Bergström T, Jönsson B, Skorpil M, Hägg O, Andersen MØ, [Antibiotics should not be used for treating back pain due to Modic changes].. Ugeskr Laeger 2020;182: " data-value-piped="Udby PM, Fritzell P, Bergström T, Jönsson B, Skorpil M, Hägg O, Andersen MØ|[Antibiotics should not be used for treating back pain due to Modic changes].|Ugeskr Laeger|2020|182||33046199" data-url="reference-link" data-pubmedid="33046199" title="Udby PM, Fritzell P, Bergström T, Jönsson B, Skorpil M, Hägg O, Andersen MØ, [Antibiotics should not be used for treating back pain due to Modic changes].. Ugeskr Laeger 2020;182: "><sup>9</sup></a></li>
    </ul>
    </li>
</ul>
<h3>Differentialdiagnoser</h3>
<h4>Dvs. andre &aring;rsager til lave rygsmerter</h4>
<ul>
    <li><a href="~/link.aspx?_id=BA77007FD5454D78BF5B5701D82C0135&amp;_z=z">Lumbal diskusprolaps</a>
    <ul>
        <li>Udgjorde i et studie kun 4 % af patienter med akutte lave rygsmerter&nbsp;</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=108C9421C8C54E7E8EF9C4B09377214A&amp;_z=z">Vertebralt kompressionsbrud</a>
    <ul>
        <li>Som f&oslash;lge af osteoporose eller metastase</li>
        <li>Udg&oslash;r mindre end 5 % af alle med rygsmerter</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=6AB4877EB60C4AD09C3FAC771904179E&amp;_z=z">Spondylolistese</a></li>
    <li><a href="~/link.aspx?_id=2B3022F9A5604E188E7E032EDBB010FC&amp;_z=z">Mb Bechterew</a></li>
    <li><a href="~/link.aspx?_id=D03A2A34FDAC4A3DB243AFD8F6175A70&amp;_z=z">Mb Scheuermann</a></li>
    <li>Spinale tumores</li>
    <li><a href="~/link.aspx?_id=FEA337568D6743A3B6DAE50693FED1CA&amp;_z=z">Myelomatose</a></li>
    <li><a href="~/link.aspx?_id=7E0B7340303E4D7282E3D9E2FD46BBB3&amp;_z=z">Spinalstenose</a>&nbsp;(s&aelig;rligt hos &aelig;ldre)</li>
    <li>Infektion, spondylit</li>
</ul>
<h2>Behandling</h2>
<h3>Behandlingsm&aring;l</h3>
<ul>
    <li>Genoptagelse af normal aktivitet og evt. supplerende smertebehandling efter n&oslash;je overvejelse&nbsp;</li>
    <li>Hindre kronisk udvikling og langvarigt frav&aelig;r fra arbejde</li>
</ul>
<h3>Generelt om behandlingen</h3>
<ul>
    <li>Konservativ behandling ved akutte gener
    <ul>
        <li>Smertestillende kun efter n&oslash;je overvejelser&nbsp;<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016" data-value-piped="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016|https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-pubmedid="undefined" title="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016"><sup>4</sup></a>&nbsp;</li>
        <li>Forts&aelig;tte vanlig aktivitet og mobilisering</li>
        <li>Evt. initiering af ledsagende&nbsp;tr&aelig;ningsprogram (<a href="~/link.aspx?_id=3F37EE5C2C4C4078896641E521E6506D&amp;_z=z">se &oslash;velsesfilm for patienter, tr&aelig;ningsprogram for l&aelig;nderyggen</a>)</li>
        <li>Manuel ledmobilisering</li>
        <li>Ingen specifikke behandlingstiltag har dokumenteret stor effekt</li>
    </ul>
    </li>
    <li>Den bedste behandling er, at patienten forbliver fysisk aktiv</li>
    <li>Overvej at opfordre patienter med nyopst&aring;ede l&aelig;nderygsmerter til at opretholde vanlig aktivitet frem for aflastning, herunder sengeleje<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016"><sup>4</sup></a></li>
    <li>Overvej at tilbyde individuelt tilpasset patientuddannelse til patienter med nyopst&aring;ede l&aelig;nderygsmerter i till&aelig;g til vanlig behandling, hvor dette vurderes at kunne &oslash;ge egenomsorgen<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016"><sup>4</sup></a>.
    <ul>
        <li>Med patientuddannelse menes en tryghedsskabende dialog om den gode prognose samt at &oslash;ge&nbsp;forst&aring;elsen af den enkeltes l&aelig;nderygsmerter, som en tilstand, hvor ryggen ikke skades ved daglige aktiviteter, arbejde, og tr&aelig;ningsigtet er dermed opretholdelse af fysiske aktivitet, sociale relationer og kontakt med arbejdsmarkedet samt at forebygge kroniske problemstillinger</li>
    </ul>
    </li>
    <li>Vedvarende gener udover 1-2 uger
    <ul>
        <li>B&oslash;r vurderes p&aring; ny for at r&aring;d og behandling kan individualiseres</li>
        <li>Identific&eacute;r evt. till&aelig;gsgener (komorbiditet) tidligt</li>
        <li>I f&oslash;lge NICE har &oslash;velser, manuel terapi, smertestillende, og kombineret fysisk og psykologisk terapi effekt<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
    </ul>
    </li>
    <li>Langvarige gener
    <ul>
        <li>Det anbefales at tilrettel&aelig;gge arbejdssituationen som et samarbejde mellem arbejdstager og arbejdsgiver, for at patienten kan forblive i eller komme hurtigt tilbage i job</li>
        <li>Risiko for recidiv er generelt stor, og sekund&aelig;rforebyggende tr&aelig;ning/tiltag b&oslash;r tilrettel&aelig;gges, og patienten b&oslash;r f&oslash;lges op</li>
        <li>Overordnet sigter indsatserne mod, at der opnås bedst muligt samlet helbred, herunder:
        <ul>
            <li>Forbedring eller fastholdelse af funktionsevne</li>
            <li>Sygdoms- og smertemestring for at opnå forbedret livskvalitet</li>
            <li>Arbejdsmarkedstilknytning</li>
        </ul>
        </li>
    </ul>
    </li>
</ul>
<h3>H&aring;ndtering i almen praksis</h3>
<ul>
    <li>Information og uddannelse af patienten</li>
</ul>
<h3>R&aring;d til patienten</h3>
<ul>
    <li>Generel aktivitet
    <ul>
        <li>Det anbefales at v&aelig;re mest mulig i normal aktivitet og at forts&aelig;tte i eller genoptage job s&aring; hurtigt som muligt - at afdramatisere</li>
        <li>Sygemelding anbefales at g&oslash;res s&aring; kort som mulig. Kombineres med t&aelig;t opf&oslash;lgning, gerne efter 1-2 uger. Vurd&eacute;r&nbsp;evt. gradueret sygemelding</li>
    </ul>
    </li>
    <li>Sengeleje
    <ul>
        <li>Kun i situationer hvor patienten ikke magter at v&aelig;re oppe</li>
        <li>Kun af v&aelig;rdi i den akutte fase</li>
        <li>Madrasser med middel h&aring;rdhed er nok lige s&aring; gode som h&aring;rde madrasser</li>
        <li>Varigheden b&oslash;r ikke overstige 2 dage, da dette kan f&oslash;re til funktionsneds&aelig;ttelse
        <ul>
            <li>Ingen forskel p&aring; sengeleje eller r&aring;d om at holde sig aktiv i den akutte fase</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Is eller varme?
    <ul>
        <li>Der er d&aring;rlig dokumentation for, om kulde eller varmebehandling har effekt<a href="EditorPage.aspx?da=core&amp;id=%7B74E03C59-1999-40A0-B4E1-88E5C2758423%7D&amp;ed=FIELD11821317523&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H11821317718&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="McIntosh G, Hall H, Low back pain (acute). BMJ Clin Evid 2011;2011: " data-value-piped="McIntosh G, Hall H|Low back pain (acute).|BMJ Clin Evid|2011|2011||21549023" data-url="reference-link" data-pubmedid="21549023" title="McIntosh G, Hall H, Low back pain (acute). BMJ Clin Evid 2011;2011: "><sup>10</sup></a>&nbsp;</li>
    </ul>
    </li>
    <li>Gode r&aring;d
    <ul>
        <li>En kortfattet opl&aelig;ring i at mestre smerte kan have lige s&aring; god effekt p&aring; ryglidelser som manuel terapi<a href="%20" title="Hay EM, Mullis R, Lewis M et al, Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice. Lancet 2005;365: 2024-30" data-url="reference-link" data-value-piped="Hay EM, Mullis R, Lewis M et al|Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice|Lancet|2005|365|2024-30" data-value="Hay EM, Mullis R, Lewis M et al, Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice. Lancet 2005;365: 2024-30" data-type="journal-reference"><sup>11</sup></a>, men opl&aelig;ring af patienter synes generelt kun at have lidt effekt<a href=" " data-type="journal-reference" data-value="Cherkin DC, Deyo RA, Battié M, Street J, Barlow W, A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.. N Engl J Med 1998;339: 1021-9" data-value-piped="Cherkin DC, Deyo RA, Battié M, Street J, Barlow W|A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.|N Engl J Med|1998|339|1021-9|9761803" data-url="reference-link" data-pubmedid="9761803" title="Cherkin DC, Deyo RA, Battié M, Street J, Barlow W, A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.. N Engl J Med 1998;339: 1021-9"><sup>12</sup></a></li>
    </ul>
    </li>
    <li>Mobilisering
    <ul>
        <li>Tidlig, gradvis mobilisering efter den akutte fase, er afg&oslash;rende for at hindre udvikling til en kronisk tilstand. Genoptagelse af normale aktiviteter s&aring; snart som muligt. "Det er ikke farligt, n&aring;r det g&oslash;r ondt"<a href="http://www.ncbi.nlm.nih.gov/pubmed/12076492" title="Hilde G, Hagen KB, Jamtvedt G, Winnem M. Advice to stay active as a single treatment for low back pain and sciatica. Cochrane Database Syst Rev, issue 2, 2006." data-url="http://www.ncbi.nlm.nih.gov/pubmed/12076492" data-value="Hilde G, Hagen KB, Jamtvedt G, Winnem M. Advice to stay active as a single treatment for low back pain and sciatica. Cochrane Database Syst Rev, issue 2, 2006." data-type="other-reference"><sup>13</sup></a></li>
        <li>Sygemeldingsperioden b&oslash;r v&aelig;re s&aring; kort som muligt</li>
    </ul>
    </li>
    <li>Tr&aelig;ning
    <ul>
        <li>Fysisk udholdenhedstr&aelig;ning</li>
        <li>Mave- og ryg&oslash;velser
        <ul>
            <li>Er sandsynligvis nyttigt ved kroniske rygsmerter, men har ingen effekt ved akutte rygsmerter</li>
        </ul>
        </li>
    </ul>
    </li>
</ul>
<h3>Medicinsk behandling</h3>
<ul>
    <li>&nbsp;For akutte l&aelig;ndesmerter g&aelig;lder<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016"><sup>4</sup></a>:
    <ul>
        <li>Tilbyd&nbsp;&nbsp;[DliActiveSubstance;6381;paracetamol]&nbsp;og NSAID i till&aelig;g til vanlig behandling til patienter med nyopståede l&aelig;nderygsmerter, s&aring;fremt der ikke er kontraindikationer mod NSAID</li>
        <li>Tilbyd kun&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/315123">opioder</a>&nbsp;i till&aelig;g til vanlig behandling til patienter med nyopståede l&aelig;nderygsmerter efter n&oslash;je overvejelse, da der ikke er dokumenteret gavnlig effekt målt 0-12 uger efter endt behandling</li>
    </ul>
    </li>
    <li>For kroniske l&aelig;ndesmerter g&aelig;lder:<a href="https://www.sst.dk/da/sygdom-og-behandling/kronisk-sygdom/faglige-anbefalinger/~/media/D995B05669A44B319734DD8206975B16.ashx" data-type="other-reference" data-value="Anbefalinger for tværsektorielle forløb for mennesker med kroniske lænderygsmerter, Sundhedsstyrelsen, 2017" data-url="https://www.sst.dk/da/sygdom-og-behandling/kronisk-sygdom/faglige-anbefalinger/~/media/D995B05669A44B319734DD8206975B16.ashx" title="Anbefalinger for tværsektorielle forløb for mennesker med kroniske lænderygsmerter, Sundhedsstyrelsen, 2017"><sup>5</sup></a>
    <ul>
        <li>Farmakologisk behandling skal aldrig st&aring; alene og b&oslash;r kun spille en mindre rolle hos patienter med kroniske l&aelig;ndesmerter</li>
        <li>Ved brug af smertestillende medicin er m&aring;let at opn&aring; bedst mulige smertelindrende effekt og ikke smertefrihed (som kun sj&aelig;ldent opn&aring;s)</li>
        <li>Anvend ikke opioder til kroniske l&aelig;ndesmerter<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
    </ul>
    </li>
    <li>Anvend kun svage opioder ([DliActiveSubstance;6038;codein]) til akutte l&aelig;ndesmerter, hvis der er kontraindikationer for NSAID, eller hvis NSAID ikke tolereres eller ikke har effekt<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
    <li>Anvend ikke neuroleptika til l&aelig;ndesmerter<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
    <li>Anvend ikke SSRI eller TCA til l&aelig;ndesmerter<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
    <li>Overvej henvisning til epidural injektion (skal foretages af l&aelig;ge med s&aelig;rlige kompentencer!) med <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/225030">lokal analagesia</a> og <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/171050">steroid</a> ved akut og meget sv&aelig;r nerverodsp&aring;virkning (sj&aelig;ldent)<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
</ul>
<h3>Anden behandling</h3>
<ul>
    <li>Traditionel fysisk aktivitet
    <ul>
        <li>R&aring;d om at v&aelig;re i aktivitet ved akutte lave rygsmerter p&aring;skynder symptombedring, reducerer kronicitet og mindsker frav&aelig;r fra job sammenlignet med sengeleje eller anden konservativ behandling&nbsp;</li>
        <li>R&aring;d om at holde sig i aktivitet som det eneste tiltag har en liden men gunstig effekt. Det har ikke skadelige effekter<a href="http://www.ncbi.nlm.nih.gov/pubmed/12076492" title="Hilde G, Hagen KB, Jamtvedt G, Winnem M. Advice to stay active as a single treatment for low back pain and sciatica. Cochrane Database Syst Rev, issue 2, 2006." data-url="http://www.ncbi.nlm.nih.gov/pubmed/12076492" data-value="Hilde G, Hagen KB, Jamtvedt G, Winnem M. Advice to stay active as a single treatment for low back pain and sciatica. Cochrane Database Syst Rev, issue 2, 2006." data-type="other-reference"><sup>13</sup></a></li>
        <li>Sengeleje, ingen bevis for nytten, tv&aelig;rtimod er resultaterne d&aring;rligere end andre typer behandling</li>
    </ul>
    </li>
    <li>Madrastype
    <ul>
        <li>Madrasser med middel h&aring;rdhed er nok s&aring; gode som h&aring;rde madrasser</li>
    </ul>
    </li>
    <li>Ryg&oslash;velser&nbsp;(<a href="~/link.aspx?_id=3F37EE5C2C4C4078896641E521E6506D&amp;_z=z">se &oslash;velsesfilm, tr&aelig;ningsprogram for l&aelig;nderyggen</a>)
    <ul>
        <li>Ved akutte rygsmerter er det ikke vist, at specielle ryg&oslash;velser (fleksion, ekstension, aerobe eller styrkende &oslash;velser) er mere effektive end anden konservativ behandling</li>
        <li>Ved kroniske rygsmerter er ryg&oslash;velser mere effektive end andre konservative tiltag</li>
    </ul>
    </li>
    <li>Psykosocial behandling
    <ul>
        <li>Synes at have effekt ved kroniske rygsmerter sammenlignet med ingen behandling</li>
        <li>Modstridende bevis om nytten i sammenligning med andre behandlinger</li>
        <li>En type adf&aelig;rdsterapi synes ikke at v&aelig;re bedre end en anden type</li>
        <li>St&aelig;rk dokumentation for at s&aring;dan behandling har en moderat lindrende effekt p&aring; smerter og en positiv effekt p&aring; generelt velv&aelig;re</li>
    </ul>
    </li>
    <li>Rygskole
    <ul>
        <li>Kan v&aelig;re effektivt&nbsp;for patienter med recidiverende eller kroniske gener i arbejdsm&aelig;ssig sammenh&aelig;ng, men lidt er kendt om kost-nytte-effekten</li>
    </ul>
    </li>
    <li>Massage
    <ul>
        <li>Kan v&aelig;re gunstigt for patienter med subakutte og kronisk uspecifikke lave rygsmerter, s&aelig;rligt hvis det kombineres med &oslash;velser og opl&aelig;ring</li>
        <li>Effekt p&aring; sygemelding er mangelfuldt vurderet</li>
    </ul>
    </li>
</ul>
<h4>Manuel terapi</h4>
<ul>
    <li>NKR angiver, at man b&oslash;r overveje at tilbyde patienter med nyopst&aring;ede l&aelig;nderygsmerter manuel ledmobiliserende behandling i till&aelig;g til vanlig behandling.<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016"><sup>4</sup></a>&nbsp;Ledmobiliserende behandling defineres her som alle manuelle teknikker, der sigter mod&nbsp;at p&aring;virke led mellem ryghvirvlerne i l&aelig;nden og i b&aelig;kkenet. Det vil sige s&aring;vel mobilisering&nbsp;inden for leddets normale bev&aelig;geomr&aring;de, herunder b&aring;de oscillerende bev&aelig;gelser,&nbsp;lav kraftp&aring;virkning, h&oslash;j kraftp&aring;virkning og &rsquo;high-velocity&rsquo; teknikker (manipulation), hvor&nbsp;der anvendes en hurtig impuls med efterf&oslash;lgende kavitation i leddet (typisk med en lyd til&nbsp;f&oslash;lge)&nbsp;</li>
    <li>Ved kroniske l&aelig;ndesmerter anbefales manual behandling kun som en kortvarende smertelindrende indsats ved opblussen i kendte symptomer og som supplement til den &oslash;vrige behandlingsindsats ved kroniske l&aelig;ndesmerter<a href="https://www.sst.dk/da/sygdom-og-behandling/kronisk-sygdom/faglige-anbefalinger/~/media/D995B05669A44B319734DD8206975B16.ashx" data-type="other-reference" data-value="Anbefalinger for tværsektorielle forløb for mennesker med kroniske lænderygsmerter, Sundhedsstyrelsen, 2017" data-url="https://www.sst.dk/da/sygdom-og-behandling/kronisk-sygdom/faglige-anbefalinger/~/media/D995B05669A44B319734DD8206975B16.ashx" title="Anbefalinger for tværsektorielle forløb for mennesker med kroniske lænderygsmerter, Sundhedsstyrelsen, 2017"><sup>5</sup></a>&nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</li>
</ul>
<h4>Fysioterapi</h4>
<ul>
    <li>Overvej at tilbyde patienter med nyopst&aring;ede l&aelig;nderygsmerter superviseret fysisk&nbsp;tr&aelig;ning i till&aelig;g til vanlig behandling jvf.&nbsp;<strong></strong>NKR 2016<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016"><sup>4</sup></a>&nbsp;</li>
    <li>Un&oslash;dvendigt i akutfasen og har heller ikke bedre effekt end generelle r&aring;d</li>
    <li>Fysioterapi b&oslash;r f&oslash;rst og fremmest indeb&aelig;re optr&aelig;ning og instruktion i egen aktiviteter
    <ul>
        <li>Der er d&aring;rlig dokumentation for, om kulde eller varmebehandling har effekt<a href="EditorPage.aspx?da=core&amp;id=%7B74E03C59-1999-40A0-B4E1-88E5C2758423%7D&amp;ed=FIELD11821317523&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H11821317718&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="McIntosh G, Hall H, Low back pain (acute). BMJ Clin Evid 2011;2011: " data-value-piped="McIntosh G, Hall H|Low back pain (acute).|BMJ Clin Evid|2011|2011||21549023" data-url="reference-link" data-pubmedid="21549023" title="McIntosh G, Hall H, Low back pain (acute). BMJ Clin Evid 2011;2011: "><sup>10</sup></a>&nbsp;</li>
    </ul>
    </li>
    <li>Fysioterapi r&aring;d versus fysioterapi behandling
    <ul>
        <li>I et studie gennemf&oslash;rt af National Health Service (NHS) i England fandt man ingen forskel i hverken omkostninger eller effekter mellem de to interventioner</li>
        <li>Men langt h&oslash;jere omkostninger for patienterne ved behandling skulle tilsige, at r&aring;d fra fysioterapeut burde v&aelig;re f&oslash;rstevalg i behandlingen</li>
    </ul>
    </li>
    <li>Massage
    <ul>
        <li>Kombination af program med massage, &oslash;velser og opl&aelig;ring har vist effekt p&aring; uspecifikke rygsmerter</li>
        <li>Effekt p&aring; sygefrav&aelig;r er mangelfuldt vurderet</li>
    </ul>
    </li>
    <li>Traktionsbehandling b&oslash;r ikke tilbydes<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
    <li>McKenzie metoden
    <ul>
        <li>Synes at kunne give kortvarig bedring i smerter og funktion&nbsp;</li>
    </ul>
    </li>
</ul>
<h4>Tr&aelig;ningsterapi</h4>
<ul>
    <li>Har ikke bedre effekt end andre tiltag i akutfasen (0-4 uger)</li>
    <li>Har nogen effekt p&aring; smerte og funktion, men har i mindre grad effekt p&aring; sygefrav&aelig;r ved subakutte og kroniske l&aelig;nderygssmerter (&gt;12 uger)</li>
    <li>Vejledende &oslash;velser/tr&aelig;ning over tid anbefales ved langvarige gener og for at forebygge recidiv</li>
    <li>Der findes ikke dokumentation for, at en bestemt form for tr&aelig;ningsterapi er bedre end en anden</li>
    <li>Om man skal anbefale l&oslash;sg&oslash;rende eller stabiliserende &oslash;velser er uafklaret, der findes studier, som underst&oslash;tter effekten af begge behandlinger</li>
    <li>Kombinationen af &oslash;velser og motivation gav bedre langtidsresultater end &oslash;velser alene i et studie</li>
</ul>
<h4>Tv&aelig;rfaglige teams</h4>
<ul>
    <li>Patienter med langvarige smerter med varighed over 4-8 uger kan have nytte af tv&aelig;rfaglige teams, som involverer egen l&aelig;ge, specialist i rehabilitering, ergoterapeut og psykolog</li>
    <li>Tv&aelig;rfaglige udredningsteam findes eller anbefales at blive oprettet</li>
    <li>Psykosocial behandling kan v&aelig;re effektivt i behandlingen af kroniske rygsmerter</li>
    <li>Intens, daglig, multidisciplin&aelig;r rehabilitering med bio-psykosociale teams, og med det sigte at genoprette funktion, er p&aring;vist at reducere smerte og bedre funktion ved kroniske lave rygsmerter
    <ul>
        <li>Det er usikkert, om dette er kost-effektivt</li>
    </ul>
    </li>
</ul>
<h4>Transkutan/perkutan nervestimulering og ultralyd</h4>
<ul>
    <li>Anvend ikke transkutan/perkutan nervestimulering eller ultralyd<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
</ul>
<h4>Akupunktur</h4>
<ul>
    <li>Tilbyd kun akupunktur teknikker i till&aelig;g til vanlig behandling til patienter med&nbsp;nyopst&aring;ede l&aelig;nderygsmerter efter n&oslash;je overvejelse, da den gavnlige effekt er usikker jf. NKR 2016<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016"><sup>4</sup></a></li>
    <li>NICE guideline frar&aring;der brug af akupunktur til l&aelig;ndesmerter<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
</ul>
<h4>Korset, rygst&oslash;tte</h4>
<ul>
    <li>NICE guideline frar&aring;der brug af korset til l&aelig;ndesmerter&nbsp;<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a></li>
</ul>
<h4>Rygskole</h4>
<ul>
    <li>Kan v&aelig;re effektivt for patienter med recidiverende eller kroniske gener i arbejdssammenh&aelig;ng, men lidt er kendt om omkostningsnytten</li>
</ul>
<h4>Alexanderteknik undervisning</h4>
<ul>
    <li>Alexanderteknik indeb&aelig;rer 1:1 undervisning af opl&aelig;rte instrukt&oslash;rer. Behandlingen g&aring;r ud p&aring; at l&aelig;re neuromuskul&aelig;r kontrol under hvile og ved aktivitet og fokuserer ogs&aring; p&aring; at fjerne sp&aelig;ndinger i nakke og ryg. Metoden beskrives som forskellig fra fysioterapi, rygskole eller andre kendte behandlingsteknikker</li>
    <li>Et studie fra almen praksis i England viste 10 f&aelig;rre smertedage pr. 24 uger efter 6 lektioner, og 18 f&aelig;rre smertedage pr. 4 uger efter 24 Alexanderteknik l&aelig;sioner - efter 1 &aring;rs opf&oslash;lgning
    <ul>
        <li>6 lektioner sammen med opfordring til tr&aelig;ning havde lige s&aring; god effekt som 24 lektioner uden tr&aelig;ning</li>
    </ul>
    </li>
</ul>
<h3>Kirurgi</h3>
<ul>
    <li>En gruppe af patienter, der har kroniske l&aelig;nderygsmerter på baggrund af strukturelle forandringer, som fx skoliose, kyfose, spondylolistese, sv&aelig;re degenerative forandringer, spinalstenose eller fraktursequelae, kan have gavn af operation</li>
    <li>Det kan overvejes at henvise til rygkirurgisk vurdering af patienter med kroniske l&aelig;nderygsmerter med henblik på eventuel operation, hvis patienten med kroniske l&aelig;nderygsmerter<a href="https://www.sst.dk/da/sygdom-og-behandling/kronisk-sygdom/faglige-anbefalinger/~/media/D995B05669A44B319734DD8206975B16.ashx" data-type="other-reference" data-value="Anbefalinger for tværsektorielle forløb for mennesker med kroniske lænderygsmerter, Sundhedsstyrelsen, 2017" data-url="https://www.sst.dk/da/sygdom-og-behandling/kronisk-sygdom/faglige-anbefalinger/~/media/D995B05669A44B319734DD8206975B16.ashx" title="Anbefalinger for tværsektorielle forløb for mennesker med kroniske lænderygsmerter, Sundhedsstyrelsen, 2017"><sup>5</sup></a>:
    <ul>
        <li>Har tegn på strukturelle forandringer fra MR-skanning med mulig årsagssammenh&aelig;ng til l&aelig;ndesmerterne, fx i form af spondylolistese, arcolyse eller sv&aelig;re degenerative forandringer</li>
        <li>Trods konservativ behandling fortsat ikke oplever bedring efter 6 m&aring;neder medf&oslash;rende fast receptpligtig smertestillende medicin eller betydende begr&aelig;nsning i daglige aktiviteter</li>
    </ul>
    </li>
    <li>NICE guidelines fra 2016 tilsiger om kirurgi<a href="https://www.nice.org.uk/guidance/ng59" data-type="other-reference" data-value="NICE guideline (2016)" data-url="https://www.nice.org.uk/guidance/ng59 " title="NICE guideline (2016)"><sup>6</sup></a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B74E03C59-1999-40A0-B4E1-88E5C2758423%7D&amp;ed=FIELD18949727981&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H18949728039&amp;us=sitecore%5Csoko&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Todd NV, The surgical treatment of non-specific low back pain. Bone Joint J 2017;99-B: 1003-1005" data-value-piped="Todd NV|The surgical treatment of non-specific low back pain.|Bone Joint J|2017|99-B|1003-1005|28768775" data-url="reference-link" data-pubmedid="28768775" title="Todd NV, The surgical treatment of non-specific low back pain. Bone Joint J 2017;99-B: 1003-1005"><sup>14</sup></a>:
    <ul>
        <li>Der b&oslash;r kun tilbydes spinal fusion s&aring;fremt man indg&aring;r i randomiseret studie</li>
        <li>Der b&oslash;r ikke tilbydes inds&aelig;ttelse af diskusprotese</li>
        <li>Overvej spinal dekompression for patienter med nerverodskompression, n&aring;r ikke-kirurgisk behandling har svigtet, og n&aring;r radiologiske fund er forenelige med nerverodsp&aring;virkning</li>
    </ul>
    </li>
</ul>
<h3>Forebyggende behandling</h3>
<ul>
    <li>Prim&aelig;r forebyggelse
    <ul>
        <li>Norske retningslinjer konkluderer, at der ikke findes dokumentation for at anbefale prim&aelig;rforebyggende tiltag</li>
        <li>En amerikansk gennemgang af litteraturen konkluderer, at der ikke findes dokumentation for at anbefale eller ikke anbefale &oslash;velsesbehandling for at forebygge ryggener</li>
    </ul>
    </li>
    <li>Sekund&aelig;r forebyggelse
    <ul>
        <li>B&aring;de norske&nbsp;og europ&aelig;iske retningslinjer&nbsp;anbefaler &oslash;velsesbehandling for at reducere sygefrav&aelig;ret, hindre tilbagefald og kronisk udvikling af ryggenerne</li>
        <li>En litteraturgennemgang konkluderer, at der er gode beviser for, at &oslash;velser/tr&aelig;ning forebygger episoder med rygsmerter
        <ul>
            <li>Ingen andre interventioner er p&aring;vist at v&aelig;re nyttige</li>
        </ul>
        </li>
    </ul>
    </li>
</ul>
<h4>P&aring; individniveau</h4>
<ul>
    <li>Vejledt tr&aelig;ning og &oslash;velser over tid</li>
    <li>Aktiv rygskole med ergonomisk f&aelig;rdighedstr&aelig;ning, kognitive aspekter og &oslash;velser/tr&aelig;ning</li>
    <li>Multimodale tiltag p&aring; arbejdspladsen med opl&aelig;ring og information, kognitive tiltag, ergonomisk tilrettel&aelig;ggelse og praktisk ergonomisk f&aelig;rdighedstr&aelig;ning. Tiltagene skal rettes mod specifikke problemer og aktivt involvere de ansatte</li>
    <li>Opvarmning f&oslash;r fysisk arbejde, specielt hvis dette er uvant</li>
    <li>En sund livsstil med regelm&aelig;ssig motion eller tr&aelig;ning</li>
    <li>Ture i skov og mark og sv&oslash;mning er ofte gunstigt</li>
    <li>St&oslash;dd&aelig;mpende skoindl&aelig;g anbefales til dem, som g&aring;r lange distancer</li>
    <li>Oph&oslash;re med at ryge</li>
    <li>Rygst&oslash;tte og b&aelig;lter forebygger ikke ryggener
    </li>
</ul>
<h2>Henvisning</h2>
<ul>
    <li>Akut indl&aelig;ggelse ved mistanke om cauda equina syndrom, evt. progredierende pareser eller paralyse, eller intraktable smerter</li>
    <li>Hurtig henvisning til hospital ved r&oslash;de flag</li>
    <li>Ved betydelige funktionsudfald, progredierende gener eller langvarigt sygefrav&aelig;r (6-8 uger) kan der henvises til rygklinik (neurolog, eller reumatolog)</li>
    <li>Kontakt med&nbsp;reumatolog eller neurolog kan v&aelig;re aktuelt ved kroniske rygsmerter, som f&oslash;rer til funktionsneds&aelig;ttelse og langvarigt sygefrav&aelig;r</li>
</ul>
<h2>Opf&oslash;lgning</h2>
<h3>Plan</h3>
<ul>
    <li>I sygemeldingsperioden
    <ul>
        <li>T&aelig;t opf&oslash;lgning, hvor en central opgave er at motivere patienten for hurtig tilbagevenden til sit arbejde</li>
    </ul>
    </li>
    <li>Opmuntre til fysisk aktivitet p&aring; trods af smerter</li>
    <li>Evt. planl&aelig;gge optr&aelig;ning i samarbejde med fysioterapeut</li>
</ul>
<h2>Sygdomsforl&oslash;b, komplikationer og prognose</h2>
<h3>Sygdomsforl&oslash;b</h3>
<ul>
    <li>Traditionelle opfattelser baseret p&aring; observationsstudier
    <ul>
        <li>30-60 % bliver raske inden 1 uge</li>
        <li>50-80 % af patienterne bliver raske inden 2 uger</li>
        <li>90 % af patienterne bliver raske inden 6 uger&nbsp;og 95 % er raske efter 12 uger</li>
    </ul>
    </li>
    <li>Fund fra et systematisk studie
    <ul>
        <li>Personer med akutte rygsmerter bliver bedre mht. smerter (ca. 60 %), funktionstab (ca. 60 %) og er tilbage i arbejde i l&oslash;bet af &eacute;n m&aring;ned (ca. 80 %)</li>
        <li>Ydermere kan en mindre bedring indtr&aelig;de i op til tre m&aring;neder efter</li>
        <li>Milde smerter og funktionstab vedvarer fra tre til mindst 12 m&aring;neder</li>
        <li>De fleste (ca. 75 %) vil opleve mindst et tilbagefald i l&oslash;bet af 12 m&aring;neder</li>
    </ul>
    </li>
</ul>
<h3>Komplikationer</h3>
<h4>Funktionsneds&aelig;ttelse</h4>
<ul>
    <li>Sengelejet har alvorlige bivirkninger
    <ul>
        <li>3 % af muskelmassen kan tabes dagligt</li>
        <li>6 % af knoglemassen kan demineraliseres dagligt</li>
    </ul>
    </li>
    <li>Restriktioner af sociale aktiviteter og sygemelding kan f&oslash;re til sygdomsadf&aelig;rd, depression og tab af interesse og motivation</li>
</ul>
<h3>Prognose</h3>
<ul>
    <li>Akutte rygsmerter recidiverer ofte og forekommer hos 40 % inden seks m&aring;neder</li>
    <li>Kronisk udvikling finder sted hos 1 % af dem med f&oslash;rstegangs optr&aelig;den af akut lumbago</li>
    <li>Ca. 2 % af befolkningen har kroniske gener</li>
</ul>
<h2>Baggrundsoplysninger<a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" data-type="other-reference" data-value="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016" data-url="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter" title="Behandling af nyopståede lænderygsmerter. NKR. Sundhedsstyrelsen. Juni 2016"><sup>4</sup></a><sup>,</sup><a href="https://www.dsam.dk/vejledninger/laendesmerter" data-type="other-reference" data-value="Lændesmerter. Klinisk vejledning. DSAM. 2006" data-url="https://www.dsam.dk/vejledninger/laendesmerter" title="Lændesmerter. Klinisk vejledning. DSAM. 2006"><sup>15</sup></a></h2>
<h3>Definition</h3>
<ul>
    <li>L&aelig;ndesmerter, lumbago </li>
    <li>Et symptomkompleks </li>
    <li>Rygsmerter med usikker organisk forklaring lokaliseret til nedre del af ryggen - l&aelig;nderyggen </li>
    <li>Smerter, muskelsp&aelig;nding og stivhed nedenfor ribbensbuen og ovenfor nedre glutealfold, med eller uden udstr&aring;ling til benene</li>
</ul>
<h4>Baseret p&aring; varighed</h4>
<ul>
    <li>Akutte rygsmerter, varighed &lt; 6 uger</li>
    <li>Subakutte rygsmerter varer 6-12 uger </li>
    <li>Langvarige rygsmerter har varighed over 12 uger
    <ul>
        <li>Mennesker, der har vedvarende smerter og betydeligt funktionsevnetab i mere end tre måneder</li>
        <li>Mennesker med recidiverende smerter, med en samlet varighed over tre måneder gennem det sidste år, der medf&oslash;rer selvoplevet &nbsp; funktionsevnebegr&aelig;nsning i et sådant omfang, at personen ikke kan udf&oslash;re eller deltage i &oslash;nskede aktiviteter</li>
    </ul>
    </li>
</ul>
<h4>Baseret p&aring; klinisk billede</h4>
<ul>
    <li>Uspecifikke l&aelig;nderygsmerter (80-90 %) </li>
    <li>L&aelig;ndesmerter med nerverodsaffektion (5-10 %) </li>
    <li>Mulig alvorlig underliggende sygdom eller neurologisk akuttilf&aelig;lde, evt. cauda equina (1-5 %) </li>
    <li>Refererede smerter fra abdominale eller thorakale lidelser 0-2 %</li>
</ul>
<h3>Forekomst&nbsp;</h3>
<ul>
    <li>
    Omkring 800.000 danskere oplever hvert år rygsmerter (<a href="https://www.sst.dk/da/sygdom-og-behandling/~/media/00C6825B11BD46F9B064536C6E7DFBA0.ashx">Sundhedsstyrelsen &amp; Statens Institut for Folkesundhed 2015</a>)</li>
    <li> Livstidspr&aelig;valens </li>
    <li>Pr&aelig;valens
    <ul>
        <li>&Aring;rligt vil 15-45 % af voksne have lave rygsmerter, 1 af 20 vil have en nyopst&aring;et tilstand </li>
        <li>I USA er det beregnet, at p&aring; ethvert tidspunkt har 5,6 % af den voksne befolkning lave rygsmerter</li>
        <li>Kun 25-30 % s&oslash;ger medicinsk hj&aelig;lp</li>
        <li>Pr&aelig;valensen af lumbal diskusprolaps er 1-3 % i almen praksis</li>
    </ul>
    </li>
    <li>Incidens
    <ul>
        <li>&Aring;rlig incidens er 3-5 %</li>
    </ul>
    </li>
    <li>Alder og k&oslash;n
    <ul>
        <li>Forekomsten er hyppigst i 30-50-&aring;rsalderen, og der er beskeden k&oslash;nsforskel</li>
    </ul>
    </li>
    <li>Pensionsudbetalinger
    <ul>
        <li>Rygsmerter er den st&oslash;rste enkeltdiagnose for social og sygeudbetalinger, udg&oslash;r
        <ul>
            <li>15 % af alle langtidssygemeldinger </li>
            <li>10 % af alle f&oslash;rtidspensioner</li>
        </ul>
        </li>
    </ul>
    </li>
</ul>
<h3>&AElig;tiologi og patogenese</h3>
<ul>
    <li>Kun hos 15 % kan der p&aring;vises en specifik &aring;rsag til smerterne
    <ul>
        <li>R&oslash;ntgenfund er d&aring;rligt korrelerede til symptomer</li>
    </ul>
    </li>
    <li>Akutte lave rygsmerter
    <ul>
        <li>Kan komme fra muskulatur, ligamenter, intervertebraldiskus (anulus fibrosus) eller facetledene </li>
        <li>Opst&aring;r ofte i forbindelse med l&oslash;ft, vrid eller voldsommere bev&aelig;gelser</li>
    </ul>
    </li>
    <li>Langvarige lave rygsmerter
    <ul>
        <li>Invaliderende kroniske l&aelig;nderygsmerter bliver oftest betragtet som et resultat af samvirke af flere faktorer: fysiske, psykologiske, sociale og arbejdsrelaterede faktorer </li>
        <li>Langvarige smerter ledsages ofte af inaktivitet og &aelig;ngstelse for at g&oslash;re bestemte bev&aelig;gelser, som giver smerte</li>
    </ul>
    </li>
</ul>
<h3>Disponerende faktorer</h3>
<h4>Individuelle faktorer</h4>
<ul>
    <li>Svagheder i ryggen - muskul&aelig;rt, i led eller i ledb&aring;nd </li>
    <li>Degenerative forandringer</li>
    <li>
    <a href="~/link.aspx?_id=7E0B7340303E4D7282E3D9E2FD46BBB3&amp;_z=z">Spinalstenose</a> </li>
    <li>
    <a href="~/link.aspx?_id=6AB4877EB60C4AD09C3FAC771904179E&amp;_z=z">Spondylolistese</a> </li>
    <li>
    <a href="~/link.aspx?_id=2DB7758B2B4E4C82B5AD9964909D028F&amp;_z=z">Skoliose</a>, kyfose og <a href="~/link.aspx?_id=FE5E83F421D941CE9856BCD52ADB510D&amp;_z=z">benl&aelig;ngdeforskel</a> - er kun af betydning ved store afvigelser </li>
    <li>Specielt h&oslash;je og overv&aelig;gtige personer har &oslash;get risiko </li>
    <li>Fysisk form, har st&oslash;rst betydning for rehabilitering </li>
    <li>Rygning </li>
    <li>Arv</li>
</ul>
<h4>Arbejdsrelaterede faktorer</h4>
<ul>
    <li>Tungt fysisk arbejde, s&aelig;rligt uvant arbejde </li>
    <li>Hyppige b&oslash;j og rotation af ryggen </li>
    <li>Hyppige l&oslash;ft og tungt arbejde </li>
    <li>Repetitivt arbejde </li>
    <li>Statiske arbejdsstillinger </li>
    <li>Vibrationer </li>
    <li>Sidde meget ned forv&aelig;rrer ofte generne</li>
</ul>
<h4>Psykosociale faktorer</h4>
<ul>
    <li>Oftest vigtigt at kortl&aelig;gge ved kroniske smerter </li>
    <li>Patienterne er ofte utilfredse med arbejdet og ser p&aring; det som kedeligt og repetitivt, eller der kan v&aelig;re stress og konflikter </li>
    <li>De har oftere end andre problemer som hovedpine, gastrointestinale gener, angst og depression, alkoholproblemer, skilsmisse og&nbsp;samlivsproblemer</li>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC]</p>
<h3>ICD-10/SKS-koder</h3>
<p>[ICD10]</p>
<h2>Patientinformation</h2>
<h3>Hvad man b&oslash;r informere patienten om</h3>
<ul>
    <li>Om betydningen af fysisk aktivitet, tidlig optr&aelig;ning, forebyggende tiltag</li>
    <li>Om betydningen af andre underliggende forhold</li>
</ul>
<h3>Hvad findes der af skriftlig patientinformation</h3>
<ul>
    <li><a href="~/link.aspx?_id=3CA71D03D86146D89408DA9D0EB55F6D&amp;_z=z">Lave rygsmerter</a></li>
</ul>
<h3>Tr&aelig;ningsfilm for l&aelig;nderyggen</h3>
<ul>
    <li><a href="~/link.aspx?_id=E6907ACE746044D89F2AB5C1757CB471&amp;_z=z">&Oslash;velsesprogram, 3 &oslash;velser</a><br>
    &nbsp;<br>
    <a href="~/link.aspx?_id=3F37EE5C2C4C4078896641E521E6506D&amp;_z=z"><img alt="Øvelsesvideo for lænderyggen." src="9C5B771B780A41A19989427EB606036A-135-84" title="Klik for at se introduktionsvideoen" style="height: 84px; width: 135px;" height="84" width="135"></a><br>
    <br>
    </li>
    <li><a href="~/link.aspx?_id=D15793BECC314248B5832D9BA9CF956B&amp;_z=z">&Oslash;velsesprogram, 3 &oslash;velser med arabisk tale - فيديوهات تمارين رياضية باللغة العربية</a><br>
    <br>
    <a href="~/link.aspx?_id=475FEDB6C4FC460DBE85104E216E5B65&amp;_z=z"><img alt="Øvelsesvideo for lænderyggen på arabisk." src="737E9F0FEE87480FBBB49E2FF87F2196-135-84" title="Klik for at se introduktionsvideoen" style="height: 84px; width: 135px;" height="84" width="135"></a></li>
</ul>
<h3>Animationer</h3>
<ul>
    <li><a href="~/link.aspx?_id=982CBF34ED1541DABCEF40DF31E0F463&amp;_z=z">Lave rygsmerter</a></li>
    <li><a href="~/link.aspx?_id=03F15453C5C447CE9E552B7C3054D503&amp;_z=z">Ryggens anatomi</a></li>
    <li><a href="~/link.aspx?_id=FB8F75564C9E41F0993FA8225A9D8A2C&amp;_z=z">Afstivning af ryg, lumbal fusion</a></li>
    <li><a href="~/link.aspx?_id=76EF467E0FB84DBA856B2C4B12F3D802&amp;_z=z">Afstivning af ryg, spinal fusion</a></li>
</ul>
<h3>Patientorganisationer</h3>
<ul>
    <li><a href="http://www.gigtforeningen.dk/">Gigtforeningen</a></li>
</ul>
<h2>Link til vejledninger</h2>
<ul>
    <li><a href="https://www.sst.dk/da/udgivelser/2016/nkr-laenderygsmerter">National klinisk retningslinje for behandling af nyopst&aring;ede l&aelig;nderygsmerter, Sundhedsstyrelsen, Juni 2016</a></li>
    <li><a href="https://www.sst.dk/da/sygdom-og-behandling/kronisk-sygdom/faglige-anbefalinger/~/media/D995B05669A44B319734DD8206975B16.ashx">Anbefalinger for tv&aelig;rsektorielle forl&oslash;b for mennesker med kroniske l&aelig;nderygsmerter, Sundhedsstyrelsen 2017</a></li>
    <li><a href="https://www.nice.org.uk/guidance/ng59">NICE guideline (2016)</a><a href="https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#pharmacological-management-of-sciatica" data-type="other-reference" data-value="NICE guideline " data-url="https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#pharmacological-management-of-sciatica" title="NICE guideline "><sup>6</sup></a></li>
    <li>Forl&oslash;bsbeskrivelser og pakkeforl&oslash;b [ICPC]&nbsp;</li>
    <li>DSAM vejledning: <a href="https://www.dsam.dk/vejledninger/laendesmerter">Diagnostik og behandling af l&aelig;ndesmerter i almen praksis (2006)</a></li>
    <li><a href="https://vaelgklogt.dk/anbefalinger/laenderyg">L&aelig;nderyg | V&aelig;lg Klogt (vaelgklogt.dk)</a></li>
    <li><a href="https://vaelgklogt.dk/anbefalinger/opioider">Opioider | V&aelig;lg Klogt (vaelgklogt.dk)</a></li>
</ul>
<h2>Illustrationer</h2>
<h3>Billeder</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=7F255A026B874B04BC43459D50AC15AB&amp;_z=z">Lumbalcolumna, side, normalt, rtg.</a> </li>
</ul>
<h3>Plancher eller tegninger</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=13351A65350B4107AF72217E35035D49&amp;_z=z">Lumbalcolumna (med prolaps), tegning</a> </li>
    <li>
    <a href="~/link.aspx?_id=1D8A64029A3044949F484B8BD6C612F0&amp;_z=z">Prolaps, tv&aelig;rsnit</a></li>
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<h3>Behandling</h3>
<ul>
    <li>Patientuddannelse om forl&oslash;b</li>
    <li>Fastholdelse af dagligdags aktiviteter</li>
    <li>Rygtr&aelig;ning</li>
</ul>
<h3>Henvisning</h3>
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