Open AccessChronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP)
Author(s) -
V. А. Parfenov,
N. N. Yakhno,
O.S. Davydov,
М. Л. Кукушкин,
M.V. Churyukanov,
В. А. Головачева,
А. И. Исайкин,
Е. Е. Ачкасов,
G. Yu. Evzikov,
А. Е. Каратеев,
Ф. А. Хабиров,
V.A. Shirokov,
E. Z. Yakupov
Publication year - 2019
Publication title -
nevrologiâ, nejropsihiatriâ, psihosomatika
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.157
H-Index - 9
eISSN - 2310-1342
pISSN - 2074-2711
DOI - 10.14412/2074-2711-2019-2s-7-16
Subject(s) - medicine , physical therapy , sacroiliac joint , massage , low back pain , acupuncture , chronic pain , back pain , physical medicine and rehabilitation , musculoskeletal disorder , manual therapy , lumbar , alternative medicine , surgery , pathology , poison control , human factors and ergonomics , environmental health
Examination of a patient with chronic low back pain (LBP) is aimed at eliminating its specific cause and assessing the social and psychological factors of chronic pain. The diagnosis of chronic nonspecific (musculoskeletal) LBP is based on the exclusion of a specific cause of pain, discogenic radiculopathy, and lumbar stenosis. It is advisable to identify possible pain sources: pathology of intervertebral disc pathology, facet joints, and sacroiliac joint and myofascial syndrome. An integrated multidisciplinary approach (a high level of evidence), including therapeutic exercises, physical activity optimization, psychological treatments (cognitive behavioral therapy), an educational program (back pain school for patients), and manual therapy, is effective in treating chronic musculoskeletal LBP. For pain relief, one may use nonsteroidal anti-inflammatory drugs in minimally effective doses and in a short cycle, muscle relaxants, and a capsaicin patch, and, if there is depressive disorder, antidepressants (a medium level of evidence). Radiofrequency denervation or therapeutic blockages with anesthetics and glucocorticoids (damage to the facet joints, sacroiliac joint), back massage, and acupuncture (a low level of evidence) may be used in some patients. Therapeutic exercises and an educational program (the prevention of excessive loads and prolonged static and uncomfortable postures and the use of correct methods for lifting weights, etc.) are recommended for preventive purposes.