medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-2-34-42medsovet-5520Research ArticleТЕРАПИЯ БОЛИPAIN THERAPYБоль в спине: от диагностики к лечениюBack pain: from diagnosis to treatmentСолохаО. А.SolokhaO. A.

Солоха Оксана Александровна, кандидат медицинских наук, заведующая неврологическим отделением

119021, Москва, ул. Россолимо, 11, стр. 1

Oksana A. Solokha, Cand. of Sci. (Med.), Head of Neurological Department

11/1, Rossolimo St., Moscow, 119021, Russia

soloxa71@mail.ruhttps://orcid.org/0000-0002-7384-6715АхмеджановаЛ. Т.АkhmedzhanovaL. T.

Ахмеджанова Луиза Талгатовна, кандидат медицинских наук, доцент кафедры нервных болезней и нейрохирургии 

119021, Москва, ул. Россолимо, 11, стр. 1

Luiza T. Akhmedzhanova, Cand. of Sci. (Med.), Associate Professor, Chair for Nervous Diseases and Neurosurgery

11/1, Rossolimo St., Moscow, 119021, Russia

luiziana78@mail.ruhttps://orcid.org/0000-0003-4971-9254КузьминоваТ. И.KuzminovaT. I.

Кузьминова Татьяна Игоревна, аспирант кафедры нервных болезней и нейрохирургии 

119021, Москва, ул. Россолимо, 11, стр. 1

Tatyana I. Kuzminova, Postgraduate Student of Chair for Nervous Diseases and Neurosurgery

11/1, Rossolimo St., Moscow, 119021, Russia

tatiana.martova@yandex.ruЛаврененкоД. С.LavrenenkoD. S.

Лаврененко Дмитрий Сергеевич, врач-невролог

119991, г. Москва, ул. Б. Пироговская, д. 6, стр. 1

Dmitriy S. Lavrenenko, Neurologist

6/1, B. Pirogovskaya St., Moscow, 119991, Russia

lavrenenkods@gmail.comУниверситетская клиническая больница №3 Первого Московского государственного медицинского университета им. И.М. СеченоваРоссияUniversity Clinical Hospital No. 3, I.M.Sechenov First Moscow State Medical UniversityRussian FederationИнститут клинической медицины им. Н.В. Склифосовского Первого Московского государственного медицинского университета им. И.М. СеченоваРоссияN.V. Sklifosovsky Clinical Medicine Institute, I.M. Sechenov First Moscow State Medical UniversityRussian Federation202003032020023442Copyright © Солоха О.А., Ахмеджанова Л.Т., Кузьминова Т.И., Лаврененко Д.С., 20202020Солоха О.А., Ахмеджанова Л.Т., Кузьминова Т.И., Лаврененко Д.С.Solokha O.A., Аkhmedzhanova L.T., Kuzminova T.I., Lavrenenko D.S.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/5520

В современном мире боль в спине является тяжелым бременем и приводит к снижению трудоспособности, а также качества жизни людей. Выбор тактики лечения боли в спине определяется ее причиной: неспецифическая (скелетно-мышечная) боль, специфическая боль, обусловленная серьезными заболеваниями, или компрессия нервного корешка. Наиболее частой причиной боли в спине является неспецифическая боль, обусловленная миофасциальным синдромом, фасеточным синдромом, а также дисфункцией крестцовоподвздошного сочленения при болях в нижней части спины. В статье представлены клинические симптомы данных синдромов, а также приемы нейроортопедического обследования, позволяющие выявить один или несколько источников боли в спине. При острой неспецифической боли для купирования болевого синдрома рекомендовано назначение нестероидных противовоспалительных средств (НПВС) и миорелаксантов. Лечение пациентов с хронической болью в спине должно быть более комплексным и включать в себя, наряду с фармакологическими методами лечения, когнитивно-поведенческую терапию и кинезиотерапию. Определение источника боли в спине при нейроортопедическом обследовании позволяет поэтапно проводить локальную терапию с применением лечебных блокад. При недостаточной эффективности лечебных блокад возможно проведение радиочастотной денервации фасеточных суставов или крестцово-подвздошного сочленения. Клиническое и нейроортопедическое обследование пациента с болью в спине с выявлением источников боли, анализа причин ее развития, адекватное лечение и рекомендации по предупреждению повторных обострений могут существенно уменьшить риск хронизации боли в спине и улучшить качество жизни пациентов.

In today ‘s world, back pain is a heavy burden and leads to a decrease in the working capacity, quality of life of people. The choice of tactics of treatment of pain in a back is defined by the pain reason: nonspecific pain, the specific pain caused by serious diseases or a compression of a root. The most frequent cause of back pain is nonspecific pain due to myofascial, muscular-tonic syndrome, facet syndrome, and sacral-iliac joint dysfunction in lower back pain. The article presents clinical symptoms of these syndrome, as well as techniques of neuroorthopedic examination, which allow to detect one or more abrasions of back pain. To prevent acute non-specific pain, it is recommended to prescribe non-steroidal anti-inflammatory drugs (NSAID) and muscle relaxants. Along with pharmacological treatments, treatment of patients with back pain should be more comprehensive and include cognitive-behavioral therapy and kinesiotherapy. Determination of the source of back pain in neuroorthopedic examination makes it possible to carry out local therapy in stages using blockages with local anesthetics and glucocorticoids. In case of insufficient effectiveness of blockades, it is possible to carry out radiofrequency denervation of facet joints or sacral-iliac). Clinical and neuroorthopedic examination of a patient with back pain with identification of sources of pain, analysis of the causes that led to its development, adequate treatment and recommendations to prevent repeated exacerbations can significantly reduce the risk of chronization of back pain and improve the quality of life of patients.

боль в спинекрестцово-подвздошное сочленениефасеточный синдромсиндром грушевидной мышцыфибромиалгияНПВСback painsacroiliac joint dysfunctionfacet jointsmyofascial painpiriformis muscle syndromefibromyalgiaNSAIDsReferencesHurwitz E.L., Randhawa K., Yu H., Côté P., Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018;27(Suppl 6):796–801. doi: 10.1007/s00586-017-5432-9.Hurwitz E.L., Randhawa K., Yu H., Côté P., Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J. 2018;27(Suppl 6):796–801. doi: 10.1007/s00586-017-5432-9.Hoy D., March L., Brooks P., et al. The global burden of low backpain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–974. doi: 10.1136/annrheumdis-2013-204428.Hoy D., March L., Brooks P., et al. The global burden of low backpain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–974. doi: 10.1136/annrheumdis-2013-204428.Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years livedwith disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. doi: 10.1016/S0140-6736(15)60692-4.Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years livedwith disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. doi: 10.1016/S0140-6736(15)60692-4.Парфенов В.А., Яхно Н.Н., Кукушкин М.Л. и др. Острая неспецифическая (скелетномышечная) поясничная боль. Рекомендации Российского общества по изучению боли (РОИБ). Неврология, нейропсихиатрия, психо¬ соматика. 2018;10(2):4–11. doi: 10.14412/2074-2711-2018-2-4-11.Parfenov V.A., Yakhno N.N., Kukushkin M.L. et al. Acute nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, nei¬ ropsikhiatriya, psikhosomatika = Neurology, neuropsychiatry, psychosomatics. 2018;10(2):4– 11. (In Russ.) doi: 10.14412/2074-2711-20182-4-11.Verhagen A.P., Downie A., Popal N., Maher C., Koes B.W. Red flags presented in current low back pain guidelines: a review. European Spine Journal. 2016;25(9):2788–2802. doi: 10.1007/s00586-016-4684-0.Verhagen A.P., Downie A., Popal N., Maher C., Koes B.W. Red flags presented in current low back pain guidelines: a review. European Spine Journal. 2016;25(9):2788–2802. doi: 10.1007/s00586-016-4684-0.Подчуфарова Е.В, Яхно Н.Н. Боль в спине. М.: ГЭОТАР-Медиа; 2009. 360 с.Podchufarova E.V., Yakhno N.N. Back pain. Moscow: GEOTAR-Media; 2009. 360 p. (In Russ.)King W., Ahmed S., Baisden J. et al. Diagnosis and treatmentof posterior sacroiliac complex pain: a systematic review with comprehensive analysis of the published data. Pain Med. 2015;16(2):257–265. doi: 10.1111/pme.12630.King W., Ahmed S., Baisden J. et al. Diagnosis and treatmentof posterior sacroiliac complex pain: a systematic review with comprehensive analysis of the published data. Pain Med. 2015;16(2):257–265. doi: 10.1111/pme.12630.Cohen S.P., Chen Y., Neufeld N. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99–116. doi: 10.1586/ern.12.148.Cohen S.P., Chen Y., Neufeld N. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013;13(1):99–116. doi: 10.1586/ern.12.148.Ou-Yang D.C., York P.J., Kleck C.J., Patel V.V. Diagnosis and Management of Sacroiliac Joint Dysfunction. The Journal of Bone and Joint Surgery. 2017;99(23):2027–2036. doi: 10.2106/jbjs.17.00245.Ou-Yang D.C., York P.J., Kleck C.J., Patel V.V. Diagnosis and Management of Sacroiliac Joint Dysfunction. The Journal of Bone and Joint Surgery. 2017;99(23):2027–2036. doi: 10.2106/jbjs.17.00245.Исайкин А.И., Кавелина А.В., Шор Ю.М., Мербаум П.А., Шадыжева Т.И. Дисфункция крестцово-подвздошного сочленения: клиническая картина, диагностика, лечение. Неврология, нейропсихиатрия, психосоматика. 2019;11(2):62–68. doi: 10.14412/20742711-2019-2S-62-68.Isaikin A.I., Kavelina A.V., Shor Yu.M., Merbaum P.A., Shadyzheva T.I. Sacroiliac joint dysfunction: clinical presentations, diagnosis, treatment. Nevrologiya, neiropsikhiatriya, psik¬ hosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2):62–68 (In Russ.) doi: 10.14412/2074-2711-2019-2S-62-68.Perolat R., Kastler A., Nicot B., Pellat J.M., Tahon F., Attye A., Krainik A. Facet joint syndrome: from diagnosis to interventional management. Insights into Imaging. 2018;9(5):773– 789. doi: 10.1007/s13244-018-0638-x.Perolat R., Kastler A., Nicot B., Pellat J.M., Tahon F., Attye A., Krainik A. Facet joint syndrome: from diagnosis to interventional management. Insights into Imaging. 2018;9(5):773–789. doi: 10.1007/s13244018-0638-x.O’Leary S.A., Paschos N.K., Link J.M., Klineberg E.O., Hu J.C., Athanasiou K.A. Facet Joints of the Spine: Structure-Function Relationships, Problems and Treatments, and the Potential for Regeneration. Annual Review of Biomedical Engineering. 2018;20(1):145–170. doi: 10.1146/annurev-bioeng-062117-120924.O’Leary S.A., Paschos N.K., Link J.M., Klineberg E.O., Hu J.C., Athanasiou K.A. Facet Joints of the Spine: Structure-Function Relationships, Problems and Treatments, and the Potential for Regeneration. Annual Review of Biomedical Engineering. 2018;20(1):145–170. doi: 10.1146/annurev-bioeng-062117-120924.Saxena A., Chansoria M., Tomar G., Kumar A. Myofascial Pain Syndrome: An Overview. Journal of Pain & Palliative Care Pharmacotherapy. 2015;29(1):16–21. doi: 10.3109/15360288.2014.997853.Saxena A., Chansoria M., Tomar G., Kumar A. Myofascial Pain Syndrome: An Overview. Journal of Pain & Palliative Care Pharmacotherapy. 2015;29(1):16–21. doi: 10.3109/15360288.2014.997853.Michel F., Decavel P., Toussirot E., Tatu L., Aleton E., Monnier G., Garbuio P., Parratte B. Piriformis muscle syndrome: diagnostic criteria and treatment of monocentric series of 250 patients. Ann Phys Rehabil Med. 2013;56(5):371–383. doi: 10.1016/j.rehab.2013.04.003.Michel F., Decavel P., Toussirot E., Tatu L., Aleton E., Monnier G., Garbuio P., Parratte B. Piriformis muscle syndrome: diagnostic criteria and treatment of monocentric series of 250 patients. Ann Phys Rehabil Med. 2013;56(5):371–383. doi: 10.1016/j. rehab.2013.04.003.Парфенов В.А., Исайкин А.И. Боль в нижней части спины: мифы и реальность. М.: ИМАПРЕСС; 2016. 104 с. Режим доступа: https://docplayer.ru/76565256-V-a-parfenov-a-i-isaykinbol-v-nizhney-chasti-spiny-mify-i-realnost.html.Parfenov V.A., Isaikin A.I. Lower back pain: myths and reality. Moscow: IMA-PRESS; 2016. 104 р. (In Russ.) Available at: https://docplayer.ru/76565256-V-a-parfenov-a-i-isaykin-bolv-nizhney-chasti-spiny-mify-i-realnost.html.Насонов Е.Л., Яхно Н.Н., Каратеев А.Е. и др. Общие принципы лечения скелетно-мышечной боли: междисциплинарный консенсус. Научно¬практическая ревматология. 2016;54(3):247–265. doi: 10.14412/19954484-2016-247-265.Nasonov E.L., Yakhno N.N., Karateev A.E., et al. General principles of treatment for musculoskeletal pain: Interdisciplinary consensus. Nauchno¬Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2016;54(3):247–265. (In Russ.) doi: 10.14412/1995-4484-2016-247-265.Nicholas M.K., Linton S.J., Watson P.J., Main C.J., the «Decade of the Flags» Working Group. Early Identification and Management of Psychological Risk Factors («Yellow Flags») in Patients With Low Back Pain: A Reappraisal. Physical Therapy. 2011;91(5):737–753. doi: 10.2522/ptj.20100224.Nicholas M.K., Linton S.J., Watson P.J., Main C.J., the «Decade of the Flags» Working Group. Early Identification and Management of Psychological Risk Factors («Yellow Flags») in Patients With Low Back Pain: A Reappraisal. Physical Therapy. 2011;91(5):737–753. doi: 10.2522/ptj.20100224.Magel J., Fritz J.M., Greene T., Kjaer P., Marcus R.L., Brennan G.P. Outcomes of Patients With Acute Low Back Pain Stratified by the STarT Back Screening Tool: Secondary Analysis of a Randomized Trial. Phys Ther. 2017;97(3):330– 337. doi: 10.2522/ptj.20160298.Magel J., Fritz J.M., Greene T., Kjaer P., Marcus R.L., Brennan G.P. Outcomes of Patients With Acute Low Back Pain Stratified by the STarT Back Screening Tool: Secondary Analysis of a Randomized Trial. Phys Ther. 2017;97(3):330– 337. doi: 10.2522/ptj.20160298.Turk D.C., Dworkin R.H., Trudeau J.J., Benson C., Biondi D.M., Katz N.P., Kim M. Validation of the Hospital Anxiety and Depression Scale in Patients With Acute Low Back Pain. J Pain. 2015;16(10):1012–1021. doi: 10.1016/j. jpain.2015.07.001.Turk D.C., Dworkin R.H., Trudeau J.J., Benson C., Biondi D.M., Katz N.P., Kim M. Validation of the Hospital Anxiety and Depression Scale in Patients With Acute Low Back Pain. J Pain. 2015;16(10):1012–1021. doi: 10.1016/j. jpain.2015.07.001.Arnold L.M., Bennett R.M., Crofford L.J., Dean L.E., Clauw D.J., Goldenberg D.L., Fitzcharles M.A., Paiva E.S., Staud R., Sarzi-Puttini P., Buskila D., Macfarlane G.J. AAPT Diagnostic Criteria for Fibromyalgia. J Pain. 2019;20(6):611–628. doi: 10.1016/j.jpain.2018.10.008.Arnold L.M., Bennett R.M., Crofford L.J., Dean L.E., Clauw D.J., Goldenberg D.L., Fitzcharles M.A., Paiva E.S., Staud R., Sarzi-Puttini P., Buskila D., Macfarlane G.J. AAPT Diagnostic Criteria for Fibromyalgia. J Pain. 2019;20(6):611–628. doi: 10.1016/j. jpain.2018.10.008.Fan A., Tournadre A., Pereira B., Tatar Z., Couderc M., Malochet-Guinamand S., Dubost J.-J. Performance of Fibromyalgia Rapid Screening Tool (FiRST) to detect fibromyalgia syndrome in rheumatic diseases. Rheumatology. 2016;55(10):1746– 1750. doi: rheumatology/kew244.Fan A., Tournadre A., Pereira B., Tatar Z., Couderc M., Malochet-Guinamand S., Dubost J.-J. Performance of Fibromyalgia Rapid Screening Tool (FiRST) to detect fibromyalgia syndrome in rheumatic diseases. Rheumatology. 2016;55(10):1746–1750. doi: rheumatology/kew244.Bernstein I.A., Malik Q., Carville S., Ward S. Low back pain and sciatica: summary of NICE guidance. BMJ. 2017;356:i6748. doi: 10.1136/bmj.i6748.Bernstein I.A., Malik Q., Carville S., Ward S. Low back pain and sciatica: summary of NICE guidance. BMJ. 2017;356:i6748. doi: 10.1136/bmj.i6748.Qaseem A., Wilt T.J., McLean R.M., Forciea M.A. for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514–530. doi: 10.7326/M16-2367.Qaseem A., Wilt T.J., McLean R.M., Forciea M.A. for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514– 530. doi: 10.7326/M16-2367.Brinjikji W., Luetmer P.H., Comstock B., et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015;36(4):811–816. doi: 10.3174/ajnr.A4173.Brinjikji W., Luetmer P.H., Comstock B., et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015;36(4):811–816. doi: 10.3174/ajnr.A4173.Каратеев А.Е., Цурган А.В. Ацеклофенак: опыт российских исследований. Современная ревматология. 2017;11(4):89–94. doi: 10.14412/1996-7012-2017-4-89-94.Karateev A.E., Tsurgan A.V. Aceclofenac: the experience of Russian studies. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2017;11(4):89–94. (In Russ.) doi: 10.14412/1996-7012-2017-4-89-94.Claxton A.J., Cramer J., Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clinical Therapeutics. 2001;23(8):1296–1310. doi: 10.1016/s0149-2918(01)80109-0.Claxton A.J., Cramer J., Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clinical Therapeutics. 2001;23(8):1296–1310. doi: 10.1016/s0149-2918(01)80109-0.Bae S.K., Kim S.-H., Lee H.W., Seong S.J., Shin S.-Y., Lee S.H., Lee H.J. Pharmacokinetics of a New Once-Daily Controlled-Release Formulation of Aceclofenac in Korean Healthy Subjects Compared with Immediate-Release Aceclofenac and the Effect of Food. Clinical Drug Investigation. 2012;32(2):111–119. doi: 10.2165/11596530-000000000-00000.Bae S.K., Kim S.-H., Lee H.W., Seong S.J., Shin S.-Y., Lee S.H., Lee H.J. Pharmacokinetics of a New Once-Daily Controlled-Release Formulation of Aceclofenac in Korean Healthy Subjects Compared with ImmediateRelease Aceclofenac and the Effect of Food. Clinical Drug Investigation. 2012;32(2):111– 119. doi: 10.2165/11596530-00000000000000.Yang J.-H., Suk K.-S., Lee B.-H., Jung W.-C., Kang Y.-M., Kim J.-H., Moon S.-H. Efficacy and safety of different aceclofenac treatments for chronic lower back pain: Prospective, randomized, single center, open-label clinical trials. Yonsei Medical Journal. 2017;58(3):637–643. Available at: https://yonsei.pure.elsevier.com/en/publications/efficacy-and-safety-of-different-aceclofenac-treatments-for-chron.Yang J.-H., Suk K.-S., Lee B.-H., Jung W.-C., Kang Y.-M., Kim J.-H., Moon S.-H. Efficacy and safety of different aceclofenac treatments for chronic lower back pain: Prospective, randomized, single center, open-label clinical trials. Yonsei Medical Journal. 2017;58(3):637– 643. Available at: https://yonsei.pure.elsevier. com/en/publications/efficacy-and-safety-ofdifferent-aceclofenac-treatments-for-chron.Pareek A., Chandurkar N., Gupta A., Sirsikar A., Dalal B., Jesalpura B., Mukherjee A. Efficacy and Safety of Aceclofenac-CR and Aceclofenac in the Treatment of Knee Osteoarthritis: A 6-Week, Comparative, Randomized, Multicentric, DoubleBlind Study. The Journal of Pain. 2011;12(5):546– 553. doi: 10.1016/j.jpain.2010.10.013.Pareek A., Chandurkar N., Gupta A., Sirsikar A., Dalal B., Jesalpura B., Mukherjee A. Efficacy and Safety of Aceclofenac-CR and Aceclofenac in the Treatment of Knee Osteoarthritis: A 6-Week, Comparative, Randomized, Multicentric, Double-Blind Study. The Journal of Pain. 2011;12(5):546– 553. doi: 10.1016/j.jpain.2010.10.013.Abdel Shaheed C., Maher C.G., Williams K.A., McLachlan A.J. Efficacy and tolerability of muscle relaxants for low back pain: Systematic review and meta-analysis. European Journal of Pain. 2016;21(2):228–237. doi: 10.1002/ejp.907.Abdel Shaheed C., Maher C.G., Williams K.A., McLachlan A.J. Efficacy and tolerability of muscle relaxants for low back pain: Systematic review and meta-analysis. European Journal of Pain. 2016;21(2):228–237. doi: 10.1002/ejp.907.Koes B.W., van Tulder M., Lin C.W., et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19:2075–2094. doi: 10.1007/s00586010-1502-y.Koes B.W., van Tulder M., Lin C.W., et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19:2075–2094. doi: 10.1007/s00586010-1502-y.Staiger T.O., Gaster B., Sullivan M.D., Deyo R. Systematic Review of Antidepressants in the Treatment of Chronic Low Back Pain. Spine. 2003;28(22):2540–2545. doi: 10.1097/01. brs.0000092372.73527.ba.Staiger T.O., Gaster B., Sullivan M.D., Deyo R. Systematic Review of Antidepressants in the Treatment of Chronic Low Back Pain. Spine. 2003;28(22):2540–2545. doi: 10.1097/01. brs.0000092372.73527.ba.Müller-Schwefe G., Morlion B., Ahlbeck K., Alon E., Coaccioli S., Coluzzi F., et al. Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Current Medical Research and Opinion. 2017;33(7):1199–1210. doi: 10.1080/03007995.2017.1298521.Müller-Schwefe G., Morlion B., Ahlbeck K., Alon E., Coaccioli S., Coluzzi F., et al. Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Current Medical Research and Opinion. 2017;33(7):1199–1210. doi: 10.1080/03007995.2017.1298521.Van Middelkoop M., Rubinstein S.M., Verhagen A.P., et al. Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol. 2010;24(2):193–204. doi: 10.1016/j.berh.2010.01.002.Van Middelkoop M., Rubinstein S.M., Verhagen A.P., et al. Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol. 2010;24(2):193–204. doi: 10.1016/j.berh.2010.01.002.Ikemoto T., Miki K., Matsubara T., Wakao N. Psychological Treatment Strategy for Chronic Low Back Pain. Spine Surgery and Related Research. 2018;3(3):199–206. doi: 10.22603/ssrr.2018-0050.Ikemoto T., Miki K., Matsubara T., Wakao N. Psychological Treatment Strategy for Chronic Low Back Pain. Spine Surgery and Related Research. 2018;3(3):199–206. doi: 10.22603/ssrr.2018-0050.Евзиков Г.Ю., Егоров О.Е., Розен А.И. Радиочастотная денервация в лечении болевого синдрома при патологии крестцовоподвздошного сочленения. Нейрохирургия. 2015;(2):80–85. Режим доступа: https://www.therjn.com/jour/article/view/169#.Evzikov G.Y., Egorov O.E., Rozen A.I. Radiofrequency denervation in the treatment of pain syndrome because of sacroiliac joint pathology. Neyrokhirurgiya = Russian journal of neurosurgery. 2015;(2):80–85. (In Russ.) Available at: https://www.therjn.com/jour/article/view/169#.

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