medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-8-46-52medsovet-5679Research ArticleТЕРАПИЯ БОЛИPAIN THERAPYВопросы терапии хронической неспецифической люмбалгииIssues of therapy of chronic non-specific lumbodyniahttps://orcid.org/0000-0002-1992-7960ПарфеновВ. А.ParfenovV. A.

Парфенов Владимир Анатольевич, д.м.н., профессор, заведующий кафедрой нервных болезней и нейрохирургии

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

Vladimir A. Parfenov, Dr. of Sci. (Med), Professor, Head of the Department of Nervous Diseases and Neurosurgery

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russia

vladimirparfenov@mail.ruhttps://orcid.org/0000-0003-4694-4202ПарфеноваЕ. В.ParfenovaE. V.

Парфенова Елена Владимировна, клинический психолог

115419, Россия, Москва, ул. Донская, д. 43

Elena V. Parfenova, clinical psychologist

43, Donskaya St., Moscow, 115419, Russia

parfenovaelenavlad@gmail.comПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)РоссияFirst Moscow State Medical University named after I.M. Sechenov (Sechenov University)Russian FederationНаучно-практический психоневрологический центр им. З.П. СоловьеваРоссияResearch and Clinical Center for NeuropsychiatryRussian Federation202014072020084652Copyright © Парфенов В.А., Парфенова Е.В., 20202020Парфенов В.А., Парфенова Е.В.Parfenov V.A., Parfenova E.V.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/5679

Боль в нижней части спины, или люмбалгия, – одна из наиболее частых причин обращения к врачу. Неспецифическая (скелетно- мышечная) боль представляет наиболее частую (90%) причину хронической люмбалгии. Хроническое течение люмбалгии определяется не только анатомическими источниками боли, но и психологическими и социальными факторами, которые следует учитывать при ведении пациентов. При лечении пациентов с хронической неспецифической люмбалгией эффективен комплексный мультидисциплинарный подход, включающий оптимизацию лекарственной терапии и двигательной активности, психологические методы, образовательную программу, мануальную терапию. При выявлении часто встречающихся эмоциональных расстройств и инсомнии требуется их терапия. Кинезитерапия (лечебная гимнастика) – наиболее эффективное направление лечения хронической неспецифической люмбалгии; ведущее значение имеют регулярность физических упражнений под контролем специалиста, исключение резких и чрезмерных движений. В комбинации с занятиями высокоэффективны регулярные пешие прогулки. Когнитивно-поведенческая терапия – наиболее эффективное психологическое направление при ведении пациентов с хронической неспецифической люмбалгией. Она должна быть направлена не только на боль, но и на часто встречающиеся при хронической неспецифической люмбалгии инсомнию, депрессию и тревожные расстройства. У части пациентов с поражением фасеточных суставов, крестцово-подвздошного сустава могут быть использованы радиочастотная денервация или лечебные блокады с анестетиками и кортикостероидами. В качестве лекарственных средств при хронической неспецифической люмбалгии используются нестероидные противовоспалительные средства, при назначении которых необходимо принимать во внимание наличие и характер факторов риска нежелательных явлений, сопутствующих заболеваний, взаимодействие с другими лекарственными средствами. Обсуждаются вопросы применения эторикоксиба при хронической неспецифической люмбалгии.

Low back pain or lumbalgia is one of the most common reasons for going to the doctor. Non-specific (musculoskeletal) pain is the most common (90%) cause of chronic lumbalgia. The chronic course of lumbalgia is determined not only by the anatomical sources of pain, but also by psychological and social factors that should be considered when managing patients. In the treatment of chronic nonspecific lumbalgia, a comprehensive multidisciplinary approach is effective, including optimization of drug therapy and motor activity, psychological methods (cognitive-behavioral therapy), an educational program, and manual therapy. When identifying common emotional disorders and insomnia, their therapy is required. Kinesitherapy (therapeutic gymnastics) is the most effective direction in the treatment of chronic nonspecific lumbalgia; оf primary importance are the regularity of physical exercises under the supervision of a specialist, the exclusion of sudden and excessive movements. In combination with activities, regular walking is highly effective. Cognitive-behavioral therapy is the most effective psychological direction in the management of patients with chronic nonspecific lumbalgia. It should be aimed not only at pain, but also at those often found in chronic non-specific lumbalgia insomnia, depression, and anxiety disorders. In some patients with damage to the facet joints, the sacroiliac joint, radiofrequency denervation or therapeutic blockades with anesthetics and corticosteroids can be used. Nonsteroidal anti-inflammatory drugs are used as medicines for chronic nonspecific lumbalgia, when prescribing them, it is necessary to take into account the presence and nature of risk factors for adverse events, concomitant diseases, interaction with other drugs The use of etoricoxib in chronic non-specific lumbalgia is discussed.

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