medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-11-48-53medsovet-6955Research ArticleТЕРАПИЯ БОЛИPAIN THERAPYПерсонализированный подход к ведению пациентов с хронической неспецифической болью в спинеA personalized approach to the management of patients with chronic nonspecific back painhttps://orcid.org/0000-0002-1992-7960ПарфеновВ. А.ParfenovV. A.

Парфенов Владимир Анатольевич, доктор медицинских наук, профессор, заведующий кафедрой нервных болезней и нейрохирургии, врач-невролог

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

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

11, Bldg. 1, Rossolimo St., Moscow, 119435

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

Парфенова Елена Владимировна, клинический психолог

115419, Москва, ул. Донская, д. 43

Elena V. Parfenova, Сlinical Рsychologist

43, Donskaya St., Moscow, 115419

elen41131@rambler.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationНаучно-практический психоневрологический центр имени З.П. СоловьеваРоссияSoloviev Research and Practical Psychoneurology CenteRussian Federation2022060720220114853Copyright © Парфенов В.А., Парфенова Е.В., 20222022Парфенов 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/6955

Боли в спине представляют одну из наиболее частых причин обращения к врачу и занимают первое место среди всех неинфекционных заболеваний по  показателю количества лет жизни, потерянных вследствие стойкого ухудшения здоровья. Неспецифическая (скелетно-мышечная) боль представляет наиболее частую причину боли и может быть вызвана грыжей межпозвоночного диска, поражением фасеточных суставов, крестцово-подвздошных суставов (КПС), мышц спины и связок. Комплексный (междисциплинарный) подход к лечению хронической боли в спине направлен не только на уменьшение боли, но и на повышение физической, социальной и бытовой активности, улучшение эмоционального состояния, выработку эффективных для преодоления боли стереотипов поведения. Персонализированный подход основывается на выяснении у пациента как анатомических причин боли, так и социальных и психологических, включая ошибочные представления о причинах боли в спине и ее прогнозе, депрессию, повышенную тревожность и нарушения сна. Кинезиотерапия представляет наиболее эффективное направление при ведении пациентов с хронической болью в спине и должна сочетаться с избеганием чрезмерных статических и физических нагрузок. В дополнение к лечебным упражнениям большое значение имеют регулярные пешие прогулки, интенсивность и объем которых могут постепенно увеличиваться. Психологические методы терапии, преимущественно когнитивно-поведенческая терапия (КПТ), эффективны при хронической неспецифической боли в спине, они требуются при наличии эмоциональных расстройств и инсомнии. При поражении фасеточных суставов, КПС, сочетанном остеоартрите коленного и  тазобедренного суставов при хронической боли в  спине в  качестве дополнительной терапии используются комбинированные препараты хондроитина сульфата и глюкозамина сульфата. К сожалению, в нашей стране редко применяется персонализированный подход, включающий КПТ, однако его использование может помочь многим пациентам с хронической болью в спине.

Back pain is one of the most common causes of a doctor visit and occupy the first place among all non-infectious diseases in terms of the number of years of life, lost due to persistent deterioration in health. Nonspecific (musculoskeletal) pain represents the most common cause of pain and can be caused by the intervertebral disc extrusion, the lesion of the facet joints, the sacroiliac joints pain (SJP), the myofascial syndrome. A comprehensive (interdisciplinary) approach to the treatment of chronic back pain is aimed not only at reducing pain, but also at increasing physical, social and domestic activity, improving the emotional state, and developing effective stereotypes of behavior. The personalized approach is based on the patient clarifying both anatomical causes of pain and social and psychological, including erroneous ideas about the causes of back pain and its forecast, depression, increased anxiety and insomnia. Kinesitherapy represents the most effective direction when conducting patients with chronic back pain and should be combined with avoiding excessive static and physical exertion. In addition to therapeutic exercises, regular walks are of great importance, the intensity and volume of which can gradually increase. Psychological methods of therapy, mainly cognitive-behavioral therapy (CBT), are effective for chronic nonspecific back pain, they also use in the presence of emotional disorders and insomnia. In case of damage to the facet joints, the SJP, combined osteoarthritis of the knee and hip joints for  chronic back pain as additional therapy, combined drugs of  chondroitin sulfate and glucosamine sulfate are used. Unfortunately, in our country, a personalized approach is rarely used, including the CBT, but its use can help many patients with chronic back pain.

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