Back and neck pain is widespread in the population. Preferably, patients of working age are sick, which leads to serious economic losses. The transition of pain from acute to chronic increases financial costs, so effective treatment of back pain is an important medical, social and economic problem. Musculoskeletal pain (MSP) prevails among all types of back pain. The source of the MSP can be various structures of the musculoskeletal system: bones, joints, muscles, fascia, tendons, ligaments, intervertebral discs. The provoking factors for the development of the MSP are static and dynamic overloads arising from physical work, long stay in a fixed posture, unprepared movements, hypothermia, vibrations. The leading diagnostic method for the MSP is a physical research of a patient which includes a detailed collection of complaints and anamnesis, inspection in statics and dynamics, carrying out global and special tests, neuroorthopedic and neurological research. In most cases, the analysis of the results obtained allows you to set a clinical diagnosis without appointing additional research methods. Two cases of acute MSP with different localization, clinical manifestations and flow are offered to the discussion. In the first case, the process was localized in the muscles of the law back. In the second patient, the muscular tonic syndrome developed in the muscles of the neck and shoulder belt and was supported by functional blockades of the vertebral motor segments. For the treatment of both patients, NSAID, muscle relaxant, glucocorticoid, as well as non-drug therapy methods were used. For local injection therapy, a drug group of glucocorticoids was used, having a sodium phosphate and betamethazone dipropionate as part of the sodium betamethasone. The combination of two betamethazone salts provides both the rapid and prolonged effect of the drug, which makes it reasonable to use it with acute musculoskeletal pain.

Acute cerebrovascular accident  (ACV) is an important medical and social problem, which is associated with high morbidity, mortality and frequent  disability. The current  system  for providing  specialized  medical  care to patients with stroke  has shown  its effectiveness, as evidenced by a decrease in hospital  mortality  and  an increase  in the  number  of patients returning  to work. However, the incidence  of stroke remains  high, which is also associated with the COVID-19 pandemic. Every third patient  with COVID-19 had neurological symptoms, and a pathomorphological study of the  brain of the  deceased showed  signs of hypoxic encephalopathy in every fifth. Due to the fact that with COVID-19 there  is a high probability of developing ischemic stroke (IS), it is necessary  to promptly identify and correct  the  following  factors  that  contribute to the  occurrence  of stroke  with COVID-19: cardiovascular  diseases, diabetes mellitus, arterial  hypertension, atherosclerosis. Direct exposure  to the virus results  in systemic inflammatory  hyperactivity  with a prothrombotic state  secondary  to protein  C and S deficiency. An important problem  is both the  prevention of the  first and recurrent  stroke, regardless of the  etiology. The basis of secondary  prevention is the  correction of risk factors, as well as the development of an individual program  with antihypertensive, lipid-lowering  therapy. The leading line of secondary  prevention of IS is antiplatelet therapy, which reduces  the risk of developing acute  vascular episodes by 25%. For the purpose  of secondary  prevention of ischemic stroke, acetylsalicylic  acid, dipyridamole, clopidogrel  are used. In the discussed clinical observation, a patient  developed repeated episodes of transient ischemic attack against  the background  of a stenosing  process  in the  common  carotid  artery, hypertension, and a previous  coronavirus  infection. Given that  the  greatest risk of recurrent  stroke is associated with atherosclerosis, which can be complicated by thrombus  formation, chimes and acetylsalicylic acid were chosen for secondary prevention. Follow-up observation showed  the correctness of the chosen tactics.

As defined in the WHO Bulletin (1999), low back pain (LBP) is pain, muscle tension or stiffness localized in the back between the XII pair of ribs and the lower gluteal folds, with or without irradiation in lower limbs. The LBP syndrome is not a nosological unit, but due to its high prevalence, social and economic importance, it has a separate heading in ICD-10 – (M 54.5). Various structures can be the source of LBP: intervertebral discs, facet and sacroiliac joints, muscles, ligaments, tendons, fascia, spinal cord and its roots, peripheral nerves, etc. Depending on which structure the source of pain is, the nature of the pain can have a nociceptive, neuropathic or mixed character, which affects the tactics of patient management. The variety of clinical manifestations of LBP introduces certain difficulties in the process of making a diagnosis and may entail the appointment of treatment methods that are inadequate for the patient’s condition. In such cases, it is advisable to conduct an additional consultation in order to obtain a second medical opinion. The message is devoted to the analysis of a clinical case of LBP. During the examination of the patient, the nature of the pain, initially regarded as neuropathic, began to be interpreted as nociceptive. In accordance with this, a complex treatment was prescribed, which included pharmacological preparations and methods of non-drug therapy. In order to quickly relieve the pain syndrome, the drug dexketoprofen was used according to a stepwise scheme. Obtaining effective anesthesia within 5 days made it possible to abandon further NSAID intake and to continue follow-up treatment with a preparation of B vitamins, a muscle relaxant and SYSADOA in combination with non-drug methods of treatment. The considered clinical case illustrates both the difficulties arising in the diagnosis of LBP and the possibilities of successful conservative therapy of this disease.

Treatment of musculoskeletal back pain is an essential problem for doctors of many specialties, including neurologists. In some cases, the chronic course of the pain syndrome is accompanied with complaints and clinical manifestations characteristic of neuropathic pain in the absence of significant damage to the neural structures, which is explained by the mechanism of central sensitization. In this case, there may be diagnostic errors in determining the nature of the pain, which entails inadequate therapy that does not lead to the desired result.The presented clinical case is devoted to the treatment of exacerbation of chronic musculoskeletal pain. Treatment of the patient for a herniated disc complicated by radiculopathy, carried out earlier, did not lead to the desired result due to the inconsistency of the diagnosis, inadequacy and lack of systematic therapy. Based on the analysis of the physical and paraclinical studies, the diagnosis was changed to « Lower back pain. Myofascial pain syndrome. Toxic polyneuropathy. Herniated disc LV-SI. Residual radiculopathy S1». Therapeutic measures were adjusted in accordance with the diagnosis. In order to relieve the pain syndrome at the first stage, a combined drug Neurodiclovit, a muscle relaxant, a drug of the SYSADOA group, soft tissue techniques of manual therapy, phonophoresis with glucocorticosteroids, and cognitive behavioral therapy were used. The assessment of the patient’s condition carried out after 7 days showed the effectiveness of the treatment, which allowed to cancel the use of a nonsteroidal anti-inflammatory drug, a muscle relaxant and a glucocorticosteroid. At the post-treatment stage, the patient was prescribed a combination of B vitamins (Neuromultivitis) and therapeutic gymnastics, as well as continued therapy with a slowacting symptomatic agent and non-drug treatment methods. Relief of the pain syndrome in the absence of adverse events confirmed the adequacy and effectiveness of the therapy.The presented clinical case demonstrates the importance of placing emphasis at the stage of diagnosis, taking into account the data of clinical and paraclinical research methods, and also illustrates the possibility of successful conservative therapy for exacerbation of chronic musculoskeletal pain in the practice of a neurologist.

Neck pain is widespread in the population and reaches 60%. Women in the age group under 60 are more likely to be affected than men. Acute pain is typical for young people, chronic – for patients of the older age group. Neck pain can be nonspecific, neural or mixed, depending on the involvement of various anatomical structures in the pathological process.Nonspecific (nociceptive, musculoskeletal) pain accounts for about 80–90% of all cases. The clinical picture may also include limited range of motion in the cervical spine (CS), changes in muscle tone in the region. With damage to the cervical spinal roots, neural symptoms join, which is observed in 11.9–43% of cases.The key to making the correct diagnosis is a deep study of complaints, anamnesis, and a thorough physical examination. Paraclinical research methods play a secondary role in the diagnosis, they are prescribed only if their results can affect the formulation of the diagnosis and further treatment. The need for differential diagnosis between nonspecific and neuropathic pain arises in the presence of complaints and clinical manifestations characteristic of both options. Standard schemes of drug therapy for nonspecific and neuropathic pain have certain differences, while they do not depend on the localization of the process and the involvement of certain structures in the process. In both cases, the main therapeutic tasks are to provide effective pain relief and influence on the inflammatory process. With these tasks, NSAIDs are most fully coping. The original diclofenac has a pronounced analgesic and anti-inflammatory effect with a high safety profile, which, together with a variety of dosage forms, makes it attractive for the treatment of various types of neck pain. An additional local effect on pathologically altered structures by the topical diclofenac forms significantly increases the effectiveness of the treatment. In the above clinical cases, two variants of neck pain are considered, which have similar symptoms, while being different forms of pathology.