medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2014-2-52-56medsovet-508Research ArticleАЛЛЕРГОЛОГИЯ И ИММУНОЛОГИЯALLERGOLOGY AND IMMUNOLOGYПричины, диагноз и лечение хронической неспецифической боли в нижней части спиныCauses, diagnosis and treatment of chronic nonspecific low back painСусловаЕ. Ю.SuslovaE. Y.noemail@neicon.ruЧерненкоА. И.ChernenkoO. A.noemail@neicon.ruПервый МГМУ им. И.М. СеченоваРоссияFirst Moscow State Medical University named after I.M.SechenovRussian Federation201430122014025256Copyright © Суслова Е.Ю., Черненко А.И., 20142014Суслова Е.Ю., Черненко А.И.Suslova E.Y., Chernenko O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/508

Ведение пациентов с болью в нижней части спины является актуальной проблемой современной медицины. Рассматриваются основные причины, принципы диагностики и лечения пациентов с хроническими неспецифическими болями в нижней части спины с точки зрения доказательной медицины. Отмечается высокая эффективность медикаментозного лечения с использованием нестероидных противовоспалительных препаратов, слабых опиоидов, антидепрессантов, лечебной физкультуры, когнитивно-поведенческой терапии в качестве компонентов мультидисциплинарного лечения.

Management of patients with low back pain is a challenge for the modern healthcare. Evidence-based approach to main causes, principles of diagnosis and treatment of patients with chronic nonspecific low back pain is described. Drug therapy with non-steroidal anti-inflammatory drugs, mild opioids, antidepressants, physical therapy and cognitive-behavioural therapy within a multimodal approach proved to be highly effective.

хроническая боль в нижней части спинынестероидные противовоспалительные препаратыдекс-кетопрофенchronic low back pain painnon-steroidal anti-inflammatory drugsdexketoprofenReferencesПарфенов В.А. Причины, диагностика и лечение боли в нижней части спины. Неврология, нейропсихиатрия, психосоматика, 2009, 1: 19-22.Парфенов В.А. Причины, диагностика и лечение боли в нижней части спины. Неврология, нейропсихиатрия, психосоматика, 2009, 1: 19-22.Подчуфарова Е.В., Яхно Н.Н. Боль в спине. М.: ГЭОТАР-Медиа, 2013.Подчуфарова Е.В., Яхно Н.Н. Боль в спине. М.: ГЭОТАР-Медиа, 2013.Вахнина Н.В. Хроническая пояснично-крестцовая боль: диагностика и лечение. Неврология, нейропсихиатрия, психосоматика, 2010, 3: 30-34.Вахнина Н.В. Хроническая пояснично-крестцовая боль: диагностика и лечение. Неврология, нейропсихиатрия, психосоматика, 2010, 3: 30-34.Цурко В.В. Пожилой возраст и боль в спине. Consilium Medicum, 2006, 8: 35-37.Цурко В.В. Пожилой возраст и боль в спине. Consilium Medicum, 2006, 8: 35-37.Алексеев В.В., Яхно Н.Н. Основные синдромы поражения нервной системы. В книге: Болезни нервной системы / под ред. Н.Н. Яхно, Д.Р Штульмана. М.: Медицина, 2001. Т. 1: 106-124.Алексеев В.В., Яхно Н.Н. Основные синдромы поражения нервной системы. В книге: Болезни нервной системы / под ред. Н.Н. Яхно, Д.Р Штульмана. М.: Медицина, 2001. Т. 1: 106-124.Подчуфарова Е.В., Яхно Н.Н. Боли в спине и конечностях. В книге: Болезни нервной системы. Под ред. Н.Н. Яхно, Д.Р. Штульмана М.: Медицина, 2005. Т. 2. С 306-331.Подчуфарова Е.В., Яхно Н.Н. Боли в спине и конечностях. В книге: Болезни нервной системы. Под ред. Н.Н. Яхно, Д.Р. Штульмана М.: Медицина, 2005. Т. 2. С 306-331.Aoki Y, Sugiura S, Nakagawa K еt al. Evaluation of nonspecific low back pain using a new detailed visual analogue scale for patients in motion, standing, and sitting: characterizing nonspecific low back pain in elderly patients. Pain Research and Treatment, 2012: 1-4.Aoki Y, Sugiura S, Nakagawa K еt al. Evaluation of nonspecific low back pain using a new detailed visual analogue scale for patients in motion, standing, and sitting: characterizing nonspecific low back pain in elderly patients. Pain Research and Treatment, 2012: 1-4.Ferrell B, Argoff CE, Epplin J. et al. Pharmacological management of persistent pain in older persons. American geriatrics society panel on the pharmacological management of persistent pain in older persons.J Am Geriatr Soc., 2009, 57 (8): 1331-46.Ferrell B, Argoff CE, Epplin J. et al. Pharmacological management of persistent pain in older persons. American geriatrics society panel on the pharmacological management of persistent pain in older persons.J Am Geriatr Soc., 2009, 57 (8): 1331-46.European guidelines for the management of chronic nonspecific low back pain. Eur Spine J., 2006, 15 (Suppl. 2): 192-300.European guidelines for the management of chronic nonspecific low back pain. Eur Spine J., 2006, 15 (Suppl. 2): 192-300.Birbara CA, Puopolo AD, Munoz DR. et al. Treatment of chronic low back pain with etoricoxib, a new cyclo-oxygenase-2 selective inhibitor: improvement in pain and disability - a randomized, placebo-controlled, 3-month trial. J Pain, 2003, 4(6):307-15.Birbara CA, Puopolo AD, Munoz DR. et al. Treatment of chronic low back pain with etoricoxib, a new cyclo-oxygenase-2 selective inhibitor: improvement in pain and disability - a randomized, placebo-controlled, 3-month trial. J Pain, 2003, 4(6):307-15.Kaplan-Machlis В, Klostermeyer BS. The cyclooxigenase-2 inhibitors: safety and effectiveness. Ann. Pharmacotherapy, 1999, 33:979-988.Kaplan-Machlis В, Klostermeyer BS. The cyclooxigenase-2 inhibitors: safety and effectiveness. Ann. Pharmacotherapy, 1999, 33:979-988.Мелкумова К.А. Когнитивно-поведенческая психотерапия при лечении хронической боли. Неврология, нейропсихиатрия, психосоматика, 2010, 1: 9-13.Мелкумова К.А. Когнитивно-поведенческая психотерапия при лечении хронической боли. Неврология, нейропсихиатрия, психосоматика, 2010, 1: 9-13.Robert J. Gatchel, Kathryn H. Rollings. Evidence informed management of chronic low back pain with cognitive behavioral therapy. Spine J., 2008, Jan-Feb, 8(1): 40-44.Robert J. Gatchel, Kathryn H. Rollings. Evidence informed management of chronic low back pain with cognitive behavioral therapy. Spine J., 2008, Jan-Feb, 8(1): 40-44.Staal JB, Hlobil H, Twisk JW et al. Graded activity for low back pain in occupational health care: a randomized, controlled trial. Ann Intern Med, 2004, 140(2): 77-84.Staal JB, Hlobil H, Twisk JW et al. Graded activity for low back pain in occupational health care: a randomized, controlled trial. Ann Intern Med, 2004, 140(2): 77-84.Sveinsdottir V, Eriksen HR, Reme SE. Assessing the role of cognitive behavioral therapy in the management of chronic nonspecific back pain. J Pain Res, 2012, 5: 371-380.Sveinsdottir V, Eriksen HR, Reme SE. Assessing the role of cognitive behavioral therapy in the management of chronic nonspecific back pain. J Pain Res, 2012, 5: 371-380.Brooks P, Emery P, Evans JE. et al. Interpreting the clinical significance of the differential inhibition of cyclooxigenase-l and cyclooxigenase-2. Rheumatol, 1999, 38: 779-788.Brooks P, Emery P, Evans JE. et al. Interpreting the clinical significance of the differential inhibition of cyclooxigenase-l and cyclooxigenase-2. Rheumatol, 1999, 38: 779-788.Feldman M, McMachon AT. Do cyclooxigenase-2 inhibitors provide benefits similar to those of traditional nonsteroidal antimflammatory drugs, with less gastrointerstinal toxicity. Ann. Intern. Med, 2000, 132: 134-143.Feldman M, McMachon AT. Do cyclooxigenase-2 inhibitors provide benefits similar to those of traditional nonsteroidal antimflammatory drugs, with less gastrointerstinal toxicity. Ann. Intern. Med, 2000, 132: 134-143.FitzGerald GA, Partono C. The coxibs, selective inhibitors of cyclooxigenase-2. N Engl J. Med., 2001, 345: 433-442.FitzGerald GA, Partono C. The coxibs, selective inhibitors of cyclooxigenase-2. N Engl J. Med., 2001, 345: 433-442.Simon LS, Smolen JS, Abramson SB. et al. Controversies in COX-2 selective inhibition. J. Rheumatology, 2002, 29: 1501-1510.Simon LS, Smolen JS, Abramson SB. et al. Controversies in COX-2 selective inhibition. J. Rheumatology, 2002, 29: 1501-1510.Strand Y, Hochberg MC. The risk of cardiovascular thrombotic events with selective cyclooxigenase-2 inhibitors. Arthritis Care Res, 2002, 47: 349-255.Strand Y, Hochberg MC. The risk of cardiovascular thrombotic events with selective cyclooxigenase-2 inhibitors. Arthritis Care Res, 2002, 47: 349-255.МcCormack K, Urquhat E. Correlation between non-steroidal anti-inflammatory drug efficacy in a clinical pain model and the dissociation of their anti-inflammatory and analgesic properties in animal model. Clin. Drug. Invest, 1995, 9: 88-97.МcCormack K, Urquhat E. Correlation between non-steroidal anti-inflammatory drug efficacy in a clinical pain model and the dissociation of their anti-inflammatory and analgesic properties in animal model. Clin. Drug. Invest, 1995, 9: 88-97.Bannwarth B, Demotes-Mainard F, Schaeverbeke T. et al. Central analgesic effects of aspirin-like drugs. Fund. Clin. Pharm, 1995, 9: 1-7.Bannwarth B, Demotes-Mainard F, Schaeverbeke T. et al. Central analgesic effects of aspirin-like drugs. Fund. Clin. Pharm, 1995, 9: 1-7.Ветшев П.С., Ветшева М.С. Принципы аналгезии в раннем послеоперационном периоде. Хирургия, 2002, 12: 49-52.Ветшев П.С., Ветшева М.С. Принципы аналгезии в раннем послеоперационном периоде. Хирургия, 2002, 12: 49-52.Marenco JL, Perez M, Navarro FJ. et al. A multicentre, randomised, double-blind study to compare the efficacy and tolerability of dexketoprofen tro-metamol versus diclofenac in the symptomatic treatment of knee osteoarthritis. Clin. Drug Invest, 2000, 19: 247-56.Marenco JL, Perez M, Navarro FJ. et al. A multicentre, randomised, double-blind study to compare the efficacy and tolerability of dexketoprofen tro-metamol versus diclofenac in the symptomatic treatment of knee osteoarthritis. Clin. Drug Invest, 2000, 19: 247-56.Rodriguez MJ, Contreras D, Galvez R et al. Double-blind evaluation of short-term analgesic efficacy of orally administered dexketoprofen trometamol and ketorolac in bone cancer pain. Pain, 2003, 104: 103-10.Rodriguez MJ, Contreras D, Galvez R et al. Double-blind evaluation of short-term analgesic efficacy of orally administered dexketoprofen trometamol and ketorolac in bone cancer pain. Pain, 2003, 104: 103-10.McGurk M, Robinson P, Rajayogeswaran V et al. Clinical comparison of dexketoprofen trometamol, ketoprofen, and placebo on dental pain. J. Clin. Pharmacol., 1998, 38 (12 Suppl.): 46-54.McGurk M, Robinson P, Rajayogeswaran V et al. Clinical comparison of dexketoprofen trometamol, ketoprofen, and placebo on dental pain. J. Clin. Pharmacol., 1998, 38 (12 Suppl.): 46-54.Ezcurdia M, Cortejoso FJ, Lanzon R. et al. Comparison of the efficacy and tolerability of dexketoprofen and ketoprofen in the treatment of primary dysmenorrhea. J. Clin. Pharmacol., 1998, 38 (12 Suppl.): 65-73.Ezcurdia M, Cortejoso FJ, Lanzon R. et al. Comparison of the efficacy and tolerability of dexketoprofen and ketoprofen in the treatment of primary dysmenorrhea. J. Clin. Pharmacol., 1998, 38 (12 Suppl.): 65-73.Beltran J, Martin-Mola E, Figueroa M. et al. Comparison of dexketoprofen trometamol and ketoprofen in the treatment of osteoarthritis of the knee. J. Clin. Pharmacol., 1998, 38 (12 Suppl.): 74-80.Beltran J, Martin-Mola E, Figueroa M. et al. Comparison of dexketoprofen trometamol and ketoprofen in the treatment of osteoarthritis of the knee. J. Clin. Pharmacol., 1998, 38 (12 Suppl.): 74-80.Carabaza A, Cabre F, Garcia AM, Rotllan E, Garcia ML, Mauleon D. Stereoselective inhibition of rat brain cyclooxygenase by dexketoprofen. Chirality 1997, 9(3): 281-285.Carabaza A, Cabre F, Garcia AM, Rotllan E, Garcia ML, Mauleon D. Stereoselective inhibition of rat brain cyclooxygenase by dexketoprofen. Chirality 1997, 9(3): 281-285.Mazario J, Roza C, Herrero JF. The NSAID dexketoprofen trometamol is as potent as mu-opioids in the depression of wind-up and spinal cord nocicep-tive reflexes in normal rats. Brain Research, 1999, Jan 23, 816(2): 512-7.Mazario J, Roza C, Herrero JF. The NSAID dexketoprofen trometamol is as potent as mu-opioids in the depression of wind-up and spinal cord nocicep-tive reflexes in normal rats. Brain Research, 1999, Jan 23, 816(2): 512-7.

The authors declare that there are no conflicts of interest present.