Cognitive functional therapy and non-steroidal anti-inflammatory drugs in the treatment of low back pain

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Non-specific low back pain (LBP) occurs in most people at least once in a lifetime. In city polyclinics, every fourth patient complains of LBP. During the COVID-19 pandemic, the prevalence of acute non-specific LBP and chronic LBP have increased due to physical inactivity, chronic stress, and anxiety. Musculoskeletal LBP is the second most common cause of disability. In this regard, it is important to consider modern principles for the diagnosis and treatment of non-specific LBP. Diagnostic algorithms, “red flags” (dangerous symptoms), “yellow flags” (chronification factors) in LBP are discussed. Own clinical cases of patients with LBP with “red flags” are presented. Effective drug and non-drug methods of treatment of LBP are considered: patient education, kinesiotherapy, cognitive-behavioral therapy, manual therapy, the use of non-steroidal anti-inflammatory drugs, muscle relaxants. The role of aceclofenac and tolperisone in the treatment of LBP is discussed, clinical studies data on the efficacy and safety of these drugs in pain syndromes are presented. We present our own clinical observation of the successful management of a patient with chronic non-specific LBP.

Non-specific low back pain: principles and algorithms for successful management of patients in real clinical practice

Головачева

Tabeeva

Golovacheva

2023

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Chronic musculoskeletal low back pain: mistakes in patient management and optimization issues

Golovacheva,

Tarshilova

2024

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We present a clinical observation of a patient with chronic musculoskeletal low back pain (CMLBP), one of the most common conditions in neurological practice. Common mistakes in the management of such patients are highlighted. The patient had previously been incorrectly diagnosed with "osteochondrosis of the spine", the back pain was by mistake associated with "age-related" organic, degenerative-dystrophic changes in the spine, and only passive treatment methods were used in the treatment — various medications, massages, physiotherapy. The factors for the development and chronification of back pain were not evaluated or corrected, therapeutic exercises were not prescribed, the rules of ergonomics and physical activity during the day were not discussed, i.e. methods that have proven to be effective and are recommended for the treatment of CMLBP. Due to an inappropriate management, the patient developed misconceptions about the disease, catastrophizing the pain and incorrect and ineffective strategies for coping with the pain, which perpetuated the chronic course of the back pain. At the Clinic for Nervous Diseases at Sechenov University, the patient was offered a comprehensive treatment approach that included educational counselling, kinesiotherapy and pharmacotherapy. Based on the patient's medical and life history and the data of an objective examination, factors for the development and chronification of back pain were identified: long-term static postures at work at a computer, physical inactivity, increased body weight, neuro-orthopedic features (“flat back”), anxiety, catastrophizing of pain, pain behavior pattern. During the treatment process, all of the above factors were considered and corrected. Kinesiotherapy included therapeutic exercises, recommendations on ergonomics and daily activity, training in correct posture and kinesio-taping. The patient took dexketoprofen as a non-steroidal anti-inflammatory drug, which is effective and relatively safe for patients with back pain. As a result of the complex treatment, the patient's pain syndrome regressed, daily activity increased and her emotional state improved; observation over 6 months showed a lasting positive effect, increasing working capacity.

Complex treatment of patients with chronic non-specific back pain and comorbid disorders: a prospective clinical study

Golovacheva,

Golovacheva

2024

A complex approach including an educational program, ergonomics, kinesiotherapy and pharmacotherapy is effective in the treatment of patients with chronic non-specific back pain (CNBP). The efficacy of complex treatment with personalized kinesiotherapy in patients with CNBP and comorbid disorders has not yet been sufficiently investigated.Objective: to evaluate the efficacy of a complex treatment including special kinesiotherapy, standard pharmacological and non-pharmacological methods in patients with CNBP and comorbid disorders.Material and methods. The study included 60 patients (12 men and 48 women, mean age 38.3±8.7 years) with CNBS and comorbid disorders (neck pain, insomnia, tension type headaches, anxiety and/or depressive symptoms). Patients were randomized into two groups: group 1 received complex treatment, including special kinesiotherapy, standard therapy (educational program, standard kinesiotherapy, non-steroidal anti-inflammatory drugs, muscle relaxers, antidepressants in some patients), group 2 – standard therapy. The clinical and psychological parameters of all patients were analyzed at baseline, and after 1, 3 and 6 months of treatment.Results. After 1 month of treatment, the clinical effect (CE) in terms of CNBS (reduction of back pain (BP) intensity according to the numerical rating scale and Oswestry questionnaire by 30% or more) was achieved in 80% of patients in group 1, which is statistically significantly (p<0.05) higher than in group 2 (46.7% of patients). By month 3 of observation, the number of patients achieving CE increased to 86.7% in group 1 and decreased to 36.6% in group 2. After 6 months, all patients in group 1 maintained the achieved CE, while in group 2 only 30% of patients maintained CE. In group 1, a complete regression of BP was observed in more than one third of patients at month 3 and 6 of observation (33.3 and 36.6%, respectively). In group 2, no regression of BP was observed in any case. In group 1, in contrast to group 2, a statistically significant (p<0.05) decrease in scores on the Beck Pain Catastrophizing Scale, the Kinesiophobia Scale, Beck Anxiety and Depression Scale, the Insomnia Severity Index, Headache Impact Index and Neck Pain Disability Index was observed. The decrease continued until the 6th month of observation.Conclusion. A complex treatment comprising special kinesiotherapy, standard non-drug and drug therapy leads to a rapid (after 1 month) positive effect in patients with CNBP and comorbid disorders that lasts over a long period of time (6 months).