逻辑感觉不对

Several studies have evaluated the clinical efficacy and cost effectiveness of integrated multidisciplinary pain treatment that is based in pain centers (121,124,155,156). Despite the nature of the typical patient population (i.e., patients refractory to other treatments) these studies generally support the efficacy of multidisciplinary pain treatment for multiple outcome criteria (23). Using “levels of evidence” to characterize studies (level 1 evidence is the highest level), it has been reported that pain reduction following such a program ranges from 20% to 40%. Studies generally report that longterm pain reductions tend to be maintained for up to 2 years (157). On the other hand, conventional medical or surgical treatment may offer less benefit in terms of long-term pain reduction. In a study of 575 patients who had undergone lumbar back surgery (level 3 evidence), 70% complained of back pain 4 to 17 years after surgery (158). In other reports (level 3 evidence), 57% of patients who had undergone spinal fusions continued to have pain in the year following surgery (159), and 66% of patients who had undergone repeated surgeries for back pain continued to have pain 5 years after the surgeries (level 3 evidence) (160). These findings are supported by several studies (level 3 evidence) and one meta-analysis (level 1 evidence) (118), which show that integrated biobehavioral rehabilitation programs return low back pain patients to work at a rate that is much higher than conventional treatments, about 40% in some centers, and are effective in other ways as well (114,119,120,121,123). A recent systematic review (level 1 evidence) examined the effect of multidisciplinary biopsychosocial rehabilitation on clinical outcomes in patients with chronic low back pain (161). This was a review of 10 randomized controlled trials in 1,964 patients, who were followed for up to 5 years after treatment. In an attempt to eliminate the potential bias of previous reviews, this review adhered to methodologic guidelines approved by the Back Review Group of the Cochrane Collaboration (162). The selected studies were not evaluated in previous reviews. In this analysis, treatment in an intensive (?100 hours of therapy) multidisciplinary biopsychosocial rehabilitation program with functional restoration was compared with inpatient or outpatient nonmultidisciplinary treatments. Key results showed strong evidence that multidisciplinary treatment improved function and moderate evidence that it reduced pain, although there was contradictory evidence regarding vocational outcome.

几项研究评价了以疼痛中心为基础的多学科疼痛综合治疗的临床疗效和成本效益(121,124,155,156)。尽管患者人群的典型性质（即，对其他治疗难治的患者），这些研究通常支持多学科疼痛治疗对多个结局标准的疗效(23)。使用“证据水平”来描述研究的特点(1级证据是最高水平)，据报道，这样治疗后的疼痛减轻幅度在20%到40%之间。研究通常报告：长期疼痛减轻一般维持长达2年(157)。另一方面，传统的内科或外科治疗在长期减轻疼痛方面获益可能较少。在一项575例接受腰椎手术患者的研究中（3级证据），70%的患者在术后4-17年主诉腰痛(158)。在其他报告中（3级证据），57%接受脊柱融合术的患者在术后一年持续疼痛(159)，66%因腰痛接受过多次手术的患者在术后5年持续疼痛（3级证据）(160)。这些发现得到了几项研究(3级证据)和一项荟萃分析(1级证据)(118)的支持，这表明综合生物行为康复计划使腰痛患者恢复工作的比率（在一些中心约为40%）远远高于传统治疗，在其他方面也有效(114,119,120,121,123)。最近的一项系统综述(1级证据)检验了多学科生物心理社会康复对慢性腰痛患者临床结果的影响(161)。这是一篇纳入1964例患者的10项随机对照试验的综述，这些患者在治疗后接受长达5年的随访。为了消除既往综述的潜在偏倚，本综述遵循Cochrane协作网反向审查组批准的方法学指南(162)。选定的研究没有在以前的综述中进行评估。在该分析中，对强化(>100小时治疗)多学科生物-心理-社会康复计划中的功能恢复治疗与住院或门诊非多学科治疗进行了比较。关键结果显示，尽管关于职业结果有相互矛盾的证据，但强有力的证据表明多学科治疗改善了功能，中等程度的证据表明它减轻了疼痛。

Despite 虽然,尽管，无论是转折或让步，这里都说不通，感觉因果关系才对，正因为难治，所以才多学科治疗