Personalized, interdisciplinary approach to the treatment of chronic low back pain: clinical observation
https://doi.org/10.21518/2079-701X-2020-11-64-69
Abstract
Nonspecific (musculoskeletal) pain is the most common cause of low back pain (LBP). Chronic nonspecific LBP is a particular problem, as it significantly reduces the quality of life and functional activity of the patient. The diagnosis of chronic non-specific LBP is made after exclusion of a specific cause of pain, discogenic radiculopathy and lumbar stenosis. Unfortunately, patients with chronic non-specific LBP are often misdiagnosed, pain chronization factors (“yellow flags”) are ignored and ineffective treatment is prescribed. Clinical observation of a patient with chronic non-specific LBP, who was initially wrongly diagnosed with spinal osteochondrosis and the treatment was ineffective, is presented. A personalized, multidisciplinary approach to treatment allowed the patient to cope with back pain and to return to his previous daily activities. The patient’s treatment plan included non-drug methods of treatment (educational conversation, physical activity, mindfulness, cognitive-behavioural therapy) and rational pharmacotherapy (non-steroidal anti-inflammatory drug, NSAID). Clinical observation showed the efficacy and good tolerability of NSAID - dexketoprofen (in the form of Dexalgin and Dexalgin 25), which was administered in a stepwise scheme for 5 days. According to modern recommendations, NSAIDs are first-line drugs in chronic non-specific LBP. The results of clinical studies on efficacy and safety in back pain of such NSAIDs as dexketoprofen and nimesulide are presented. In case of prolonged exacerbation the possibility of dexketoprofen prescription with subsequent transition to nimesulide is discussed.
About the Authors
V. A. Golovacheva
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Veronika A. Golovacheva, Cand. of Sci. (Med.), Assistant Professor of the Department of Nervous Diseases and Neurosurgery of the Institute of Clinical Medicine
8, Bldg. 2, Trubetskaya St., Moscow, 119991
A. A. Golovacheva
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Anzhelika A. Golovacheva, 6th-year student of the Institute of Clinical Medicine
8, Bldg. 2, Trubetskaya St., Moscow, 119991
References
1. Podchufarova E.V., Yakhno N.N. Backache. Moscow: GEHOTAR-Media; 2010. 368 p. (In Russ.)
2. Yahno N.N., Kukushkin M.L., Churyukanov M.V., Syrovegin A.V. The results of open multicentral study “MERIDIAN” for assessment of pain syndromes prevalence in ambulatory and therapeutic preferences of physicians. Rossiysky zhurnal boli = Russian Journal of Pain. 2012;(3–4):10–14. (In Russ.) Available at: https://elibrary.ru/item.asp?id=20343058.
3. Parfenov V.A., Isaikin A.I. Pain in the lower back: myths and reality. Moscow: IMA-PRESS; 2016. 104 p. (In Russ.)
4. Kukushkin M.L., Tabeeva G.R., Podchufarova E.V.; Yakhno N.N. (ed.). Pain syndrome: pathophysiology, clinic, treatment. Clinical guidelines. 2nd ed. Moscow: IMA-PRESS; 2014. 72 p. (In Russ.)
5. Parfenov V.A., Golovacheva V.A. Chronic pain and its treatment in neurology. Moscow: GEOTAR-Media; 2018. 288 p. (In Russ.)
6. Parfenov V.A., Yakhno N.N., Davydov O.S., Kukushkin M.L., Churyukanov M.V., Golovacheva V.A. et al. Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2S):7–16. (In Russ.) doi: 10.14412/2074-2711-2019-2S-7-16.
7. Qaseem A., Wilt T.J., McLean R.M., Forciea M.A. 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.
8. Oliveira C.B., Maher C.G., Pinto R.Z., Traeger A.C., Lin C.C., Chenot J.F. et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791–2803. doi: 10.1007/s00586-018-5673-2.
9. Golovacheva V.A., Parfenov V.A., Tabeeva G.R., Osipova V.V., Smulevich A.B., Andrushchenko A.V., Golovacheva A.A. The optimization of management of chronic daily headache patients. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2017;117(2):4–9. (In Russ.) doi: 10.17116/jnevro2017117214-9.
10. Gilveg A.S., Parfenov V.A., Evzikov G.Yu. Carpal tunnel syndrome: issues of diagnosis and treatment. Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2S):46–51. (In Russ.) doi: 10.14412/2074-2711-2019-2S-46-51.
11. Antonenko L.M., Parfenov V.A. A specialized approach to diagnosing and treating vertigo. Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2016;8(1):56–60. (In Russ.) doi: 10.14412/2074-2711-2016-1-56-60.
12. Isaikin A.I., Ivanova M.A., Kavelina A.V., Chernenko O.A. Lumbar discogenic pain. Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2016;8(3):88–94. (In Russ.) doi: 10.14412/2074-2711-2016-3-88-94.
13. Soloveva E., Karneev A., Fedin A. Combined use of Dexalgin and Nimesil in the stage of dorsopathy exacerbation. Vrach = Doctor. 2007;(3):67–71. (In Russ.) Available at: https://elibrary.ru/item.asp?id=12974322.
14. Soloveva E.Yu., Karneev A.N., Ivanokov A.N., Dzhutova E.D. Декскетопрофен в лечении острой боли в спине. Effektivnaya farmakoterapiya. Nevrologiya i psihiatriya = Effective Pharmacotherapy. Neurology and Psychiatry. 2012;(5):36–40. (In Russ.) Available at: https://www.umedp.ru/upload/iblock/8c1/8c182cde09801d0367615e2c18fb49a1.pdf.
15. Moore R.A., Barden J. Systematic review of dexketoprofen in acute and chronic pain. BMC Clin Pharmacol. 2008;8:11. doi: 10.1186/1472-6904-8-11.
16. Rainsford K.D. Current status of the therapeutic uses and actions of the preferential cyclo-oxygenase-2 NSAID, nimesulide. Inflammopharmacology. 2006;14(3–4):120–137. doi: 10.1007/s10787-006-1505-9.
17. Alexeeva L.I., Karateev A.E., Popkova T.V., Novikova D.S., Sharapova E.N., Markelova E.P., Nasonov E.L. Efficacy and safety of nimesulide long term administration in patients with osteoarthritis: results of 12-months open controlled study DINAMO (long term administration of nimesulide in osteoarthritis multifactor assessment). Nauchnoprakticheskaya revmatologiya = Rheumatology Science and Practice. 2009;47(4):64–72. (In Russ.) doi: 10.14412/1995-4484-2009-1152.
18. Laporte J.R., Ibáñez L., Vidal X., Vendrell L., Leone R. Upper gastrointestinal bleeding associated with the use of NSAIDs: newer versus older agents. Drug Saf. 2004;27(6):411–420. doi: 10.2165/00002018-200427060-00005.
19. Conforti A., Leone R., Moretti U., Mozzo F., Velo G. Adverse drug reactions related to the use of NSAIDs with a focus on nimesulide: results of spontaneous reporting from a Northern Italian area. Drug Saf. 2001;24(14):1081–1090. doi: 10.2165/00002018-200124140-00006.
20. Podchufarova E.V. Low back pain: diagnosis and treatment. RMZH = RMJ. 2005;(27):1893–1899. (In Russ.) Available at: https://www.rmj.ru/articles/nevrologiya/Boly_v_poyasnichno-krestcovoy_oblastidiagnostika_lechenie.
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For citations:
Golovacheva VA, Golovacheva AA. Personalized, interdisciplinary approach to the treatment of chronic low back pain: clinical observation. Meditsinskiy sovet = Medical Council. 2020;(11):64-69. (In Russ.) https://doi.org/10.21518/2079-701X-2020-11-64-69
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