medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-11-114-120medsovet-6964Research ArticleПРАКТИКАPRACTICEВедение пациентов с хронической поясничной болью и фибромиалгиейManagement of patients with chronic low back pain and fibromyalgiahttps://orcid.org/0000-0003-4971-9254НасоноваТ. И.NasonovaT. I.

Насонова Татьяна Игоревна, врач-невролог 3-го неврологического отделения Клиники нервных болезней А.Я. Кожевникова, аспирант кафедры нервных болезней и нейрохирургии Института клинической медицины имени Н.В. Склифосовского

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

Tatiana I. Nasonova, Neurologist, Kozhevnikov 3rd Neurological Department of the Clinic of Nervous Diseases, Postgraduate Student, Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine

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

tatiana.martova@yandex.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202206072022011114120Copyright © Насонова Т.И., 20222022Насонова Т.И.Nasonova T.I.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/6964

Ведение пациентов с хронической поясничной болью и фибромиалгией (ФМ) представляет актуальную проблему современной медицины. В  реальной клинической практике ФМ часто не  диагностируется, при хронической боли в  спине не выявляются сочетанные заболевания, поэтому пациенты не получают комплексной терапии, что продемонстрировано на примере двух клинических наблюдений. Одна из пациенток страдала хронической люмбалгией (скелетно-мышечная поясничная боль на фоне поражения нижних поясничных фасеточных суставов), хронической инсомнией, тревожными расстройствами. Вторая пациентка страдала ФМ в  сочетании с  артрозом тазобедренных суставов и  крестцовоподвздошного сочленения. Комплексное персонализированное лечение, которое включало выявление и лечение сочетанных заболеваний, работу с неправильными представлениями пациентов о причинах боли, составление прогноза и планирование физической активности, проведение образовательной программы с  элементами когнитивно-поведенческой терапии (КПТ), регулярные лечебные упражнения и фармакотерапию, что в итоге привело к существенному улучшению состояния больных. В обоих наблюдениях был достигнут стойкий (в течение 6 мес.) положительный эффект в виде снижения боли, улучшения функционального состояния, эмоционального статуса и сна пациентов. Также в исследовании обсуждаются вопросы эффективной терапии хронической скелетно-мышечной поясничной боли и ФМ, плохой информированности врачей о ФМ и критериях ее диагностики. Отмечается, что регулярные лечебные упражнения, ограничение чрезмерных физических и статических нагрузок составляют основу ведения пациентов с хронической болью в спине. Пациенты с хронической болью в спине часто имеют ошибочное представление о своем заболевании, его прогнозе, эффективных методах терапии, поэтому выявление и разрешение этих проблем с использованием КПТ способствуют положительному результату лечения.

 

Management of patients with chronic low back pain and fibromyalgia is an urgent problem of modern medicine. In real clinical practice, fibromyalgia (FM) is often undiagnosed, with chronic back pain no combined diseases are detected, so patients do not receive comprehensive therapy, as demonstrated by two clinical observations. One patient suffered from chronic lumbodynia (skeletal-muscular lumbar pain against the background of lower lumbar facet joint lesions), chronic insomnia, anxiety disorders. The second patient suffered from FM combined with osteoarthritis of the hip joints and sacroiliac joint. Comprehensive personalized treatment, which included identifying and treating comorbidities, working with patients’ misconceptions about the causes of pain, predicting and planning physical activity, conducting an educational program with elements of cognitive behavioral therapy (CBT), regular exercise therapy, and pharmacotherapy, led to significant improvement in the patients’ condition. In both observations, a persistent (for 6 months) positive effect in the form of pain reduction, improvement of the functional state, emotional status, and sleep of the patients was achieved.he study also discusses the issues of effective therapy of chronic musculoskeletal chronic lumbar pain and FM, doctors’ poor awareness of FM and criteria for its diagnosis. It is noted that regular therapeutic exercises, restriction of excessive physical and static loads form the basis of management of patients with chronic back pain. Patients with chronic back pain often have misconceptions about their disease, its prognosis, and effective therapies, so identifying and resolving these problems using CBT contributes to a positive treatment outcome.

 

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