[New guidelines for the management of low back pain in general practice - «Stop pain without drugs¼]. / Nouvelles recommandations de prise en charge des lombalgies communes en cabinet - «Stop pain without drugs¼.

The so-called 4P medicine, preventive, predictive, participatory, and personalized, which places the patient at the center has influenced the latest recommendations for the management of common low back pain. The management of low back pain in the acute, subacute, and chronic phase is currently based on the profile of each patient with their risk factors, their prognosis, and the respect of their preferences, promoting an integrative approach. During the first consultation, it is important to identify factors of moderate to poor prognosis, including kinesiophobia and to search for false beliefs, through a detailed medical history. The non-pharmacological approaches are more effective and have less side effects than the medications. Reassurance and therapeutic education are the first steps in good management of common low back pain.

La médecine dite des 4P, préventive, prédictive, participative et personnalisée, a influencé les dernières recommandations de prise en charge des lombalgies communes. La prise en charge de ces dernières en phases aiguë, subaiguë et chronique se base sur le profil de chaque patient avec ses facteurs de risque, son pronostic et le respect de ses préférences, en valorisant une approche intégrative. Dès la première consultation, il est important d'identifier des facteurs de pronostic moyen à mauvais dont la kinésiophobie et la recherche de fausses croyances grâce à une anamnèse détaillée. Les approches non pharmacologiques sont plus efficaces et ont moins d'effets secondaires que les médicaments. La réassurance et l'éducation thérapeutique sont les ingrédients d'une bonne prise en charge des lombalgies communes.

Hypofractionated radiotherapy for prostate cancer in the postoperative setting: What is the evidence so far?

Postoperative external beam radiation therapy (EBRT) is a validated treatment option in the adjuvant setting for prostate cancer patients with aggressive pathological features following radical prostatectomy (RP) or as salvage modality in patients with biochemical recurrence after RP. Contemporary randomized phase III trials have provided evidence for using hypofractionation in the definitive treatment setting as an alternative to standard fractionated regimens. Biomathematical modeling for prostate cancer fractionated EBRT associated with widely available refined treatment delivery techniques such as volumetric modulated-arc therapy with image-guided RT may improve the therapeutic ratio. Nevertheless, the role of hypofractionation in the postoperative setting still remains investigational. In this systematic review of the literature we reviewed the role of hypofractionation for postoperative EBRT in the adjuvant or salvage setting in prostate cancer patients previously treated by RP. A favorable acute toxicity profile with, at least, as good biochemical control rates with hypofractionation has been suggested. And yet conflicting results have been reported concerning long-term genitourinary late toxicity. Prospective studies are eagerly awaited to assess the role of hypofractionation in the postoperative setting.