medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-8-65-70medsovet-5681Research ArticleТЕРАПИЯ БОЛИPAIN THERAPYБоль в нижней части спины: что должен знать врач?Low back pain: what should a doctor know?https://orcid.org/0000-0002-7465-0677ПизоваН. В.PizovaN. V.

Пизова Наталия Вячеславовна, д.м.н., профессор, кафедра нервных болезней с медицинской генетикой и нейрохирургией

150000, Россия, Ярославль, ул. Революционная, д. 5

Nataliia V. Pizova, Dr. of Sci. (Med.), Professor, Department of Nervous Diseases, Neurosurgery and Medical Genetics

5, Revolutsionnaya St., Yaroslavl, 150000, Russia

pizova@yandex.ruЯрославский государственный медицинский университетРоссияYaroslavl State Medical UniversityRussian Federation202014072020086570Copyright © Пизова Н.В., 20202020Пизова Н.В.Pizova N.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/5681

Боль в нижней части спины является важной проблемой здравоохранения и одной из основных причин инвалидности во всем мире, а также симптоматическим и доброкачественным состоянием. Описаны основные механические, системные и неспецифические причины ее развития. Детально рассмотрены симптомы «красных флажков», которые требуют особого внимания со стороны практикующего врача, а при их выявлении – тщательного диагностического поиска причин болевого синдрома. Отмечено, что специфическая причина боли может быть обнаружена только у небольшого процента пациентов. Сделан акцент на диагностику и дифференциальную диагностику, проводимую у лиц с болью в нижней части спины, с указанием на особенности анамнестических данных и результатов объективного осмотра. Неконтрастная магнитно- резонансная томография считается лучшим методом визуализации для исследования боли в пояснице, когда не удается консервативное лечение или когда присутствуют «красные флажки», указывающие на основную причину боли. Визуализация не рекомендуется для большинства пациентов с неспецифической механической болью в пояснице. Представлены основные терапевтические стратегии острой и хронической боли в нижней части спины. Для лечения острой или хронической боли в нижней части спины можно применять несколько методов лечения, направленных на уменьшение интенсивности болевого синдрома и улучшение качества жизни пациента. Описаны основные группы препаратов, применяемых у этих пациентов. Более углубленно рассмотрены нестероидные противовоспалительные препараты, и особенно нимесулид.

Low back pain is an important public health problem and one of the major causes of disability worldwide, as well as a symptomatic and benign condition. The article describes the main mechanical, systemic and non-specific causes of pain development. The “red flag” symptoms, which call for special attention from the practitioner, are considered in detail and if they are detected, a thorough diagnostic search for the causes of the pain syndrome is required. It is noted that a specific cause of pain can only be detected in a small percentage of patients. Emphasis is placed on the diagnosis and differential diagnosis carried out in individuals with low back pain, indicating the features of anamnestic data and the results of an objective examination. Non-contrast magnetic resonance imaging is considered the best imaging method for examining low back pain, when conservative treatment fails or when red flag symptoms indicating the underlying cause of the pain are present. Imaging is not recommended for most patients with nonspecific mechanical low back pain. The author presents the main therapy approaches in the treatment of acute and chronic low back pain. Several treatment methods can be used to treat acute or chronic low back pain, which are aimed at reducing the intensity of pain syndrome and improving the patient’s quality of life. The main groups of drugs used in these patients are described. Non-steroidal anti-inflammatory drugs and nimesulide in particular are discussed in more depth.

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