Chronic nonspecific low back pain: Causes, diagnosis, and treatment

Chronic nonspecific (musculoskeletal) low back pain (CNLBP) is one of the most common causes of temporary disability and decreased quality of life. Risk factors for CNLDP include heavy physical labor, excessive flexion and extension, frequent bending, heavy lifting, a sedentary lifestyle, and exposure to vibration. Chronic low back pain is facilitated not only by pathological changes (damage to the intervertebral disc, facet joint, sacroiliac joint, muscles, and ligaments), but also by inadequate treatment of acute pain, excessive limitation of physical activity, a “pain-prone” personality type, and anxiety and depressive disorders (social and psychological factors of pain). The diagnosis of CNLBP is based on a clinical examination and the absence of signs of dangerous disease (“red flags”), radiculopathy, and spinal stenosis. In chronic lower back pain, it is recommended to inform the patient about the favorable prognosis of the disease and its risk factors, the need to avoid excessive static and physical stress, incorrect positions and postures, and the advisability of maintaining physical, social, and professional activity. A multimodal approach is most effective in chronic lower back pain, which, as non-drug methods, should include an educational program, therapeutic physical exercises, manual therapy, and, for some patients, psychological therapy methods. Non-steroidal anti-inflammatory drugs (NSAIDs) are most often used to reduce pain in chronic lower back pain. The efficacy and safety of etoricoxib (Arcoxia) as an NSAID and local administration of Diprospan for lesions of the lumbar facet joints and lumbosacral articulation are discussed. To prevent low back pain, therapeutic exercises and an educational program on avoiding excessive static and physical stress, incorrect positions and postures are recommended.

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