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Острая боль в нижней части спины и шее
Острая боль в нижней части спины и шее
Котова О.В. Острая боль в нижней части спины и шее. Consilium Medicum. 2016; 18 (9): 122–124. DOI: 10.26442/2075-1753_2016.9.122-124
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Аннотация
Острая боль в нижней части спины и шее является распространенной причиной получения медицинской помощи. Затраты, связанные с этой патологией, представляют серьезную финансовую нагрузку на общество в развитых странах. Стабильность позвоночника обеспечивается за счет связок и мышц спины и живота. Некоторые авторы выделяют так называемую механическую боль в нижней части спины, которая связана с нарушением биомеханики позвоночника, является костно-мышечной болью и не связана с компрессией нерва или серьезным заболеванием позвоночника. Распространенность такой боли выше у молодых и активных взрослых. Наиболее распространенным типом боли в шее является неспецифическая («механическая», аксиальная) боль. Часто точную причину или происхождение ее определить не представляется возможным. Для купирования острой боли в спине и шее наиболее широкое применение получили нестероидные противовоспалительные препараты. Из этой группы препаратов выделяется кеторолак (Кеторол), обезболивающий эффект которого в дозе 30 мг, введенного внутримышечно, сопоставим с эффектом 10–12 мг морфина или 50 мг меперидина. Ограничение сроков лечения способно надежно повысить безопасность терапии кеторолаком.
Ключевые слова: острая боль в нижней части спины, боль в шее, нестероидные противовоспалительные препараты, кеторолак.
Ключевые слова: острая боль в нижней части спины, боль в шее, нестероидные противовоспалительные препараты, кеторолак.
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Acute pain in the lower back and the neck is a common reason for medical care. The costs associated with this disease, pose a serious financial burden on society in the developed countries. spine stability is ensured by ligaments and muscles of the back and abdomen. Some authors identify the so-called mechanical pain in the lower back, which is associated with the violation of the biomechanics of the spine, it is a musculoskeletal pain and is not associated with nerve compression or serious spine disease. The prevalence of such pain is higher in young and active adults. The most common type of neck pain is non-specific ( "mechanical", axial) pain. Often the exact cause or origin of it can not be evaluated. For relief of acute pain in the back and neck most widely used non-steroidal anti-inflammatory drugs. From this group of drugs ketorolac (Ketorol) is often selected, with its analgesic effect at a dose of 30 mg, to be administered intramuscularly, is comparable to the effect of 10–12 mg of morphine or 50 mg of meperidine. Limiting the duration of treatment is able to reliably increase the safety of ketorolac therapy.
Key words: acute pain in the lower back, neck pain, non-steroidal anti-inflammatory drugs, ketorolac.
Key words: acute pain in the lower back, neck pain, non-steroidal anti-inflammatory drugs, ketorolac.
Полный текст
Список литературы
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26. Котова О.В., Акарачкова Е.С. Острые болевые синдромы в неврологической практике. Эффективная фармакотерапия. 2014; 31: 40–5. / Kotova O.V., Akarachkova E.S. Ostrye bolevye sindromy v nevrologicheskoi praktike. Effektivnaia farmakoterapiia. 2014; 31: 40–5. [in Russian]
27. Henschke N, Maher CG, Refshauge KM et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ 2008; 337: a171.
28. Van Tulder M, Becker A, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (2): 169–91.
29. Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for the aspiei-like drugs. Nature 1971; 231: 235–9.
30. Pérez-Urizar J, Granados-Soto V et al. Analgesic efficacy and bioavailability of ketorolac in postoperative pain: a probability analysis. Arch Med Res 2000; 31 (2): 191–6.
31. Veenema KR, Leahey N, Schneider S. Ketorolac versus meperidine: ED treatment of severe musculoskeletal low back pain. Am J Emerg Med 2000; 18 (4): 404–7.
32. Innes GD, Croskerry P. Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain. J Emerg Med 1998; 16 (4): 549–56.
33. Bjarnason I. Gastrointestinal safety of NSAIDs and over‐the‐counter analgesics. Int J Clin Pract 2013; 178 (Suppl.): 37–42.
34. Feldman HI, Kinman JL, Berlin JA et al. Parenteral ketorolac: the risk for acute renal failure. Ann Intern Med 1997; 126 (3): 193–9.
2. Statistical year book of the social insurance institution 2013. Kansaneläkelaitos – The Social Insurance Institution of Finland 2015. http://www.kela.fi/documents/10180/1630875/Statistical_Yearbook_of_the_Social_Insurance_Institution_....
3. Hakala P, Rimpelä A, Salminen JJ et al. M. Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys. Brit Med J 2002; 325: 743–5. doi: 10.1136/bmj.325.7367.743.
4. Calvo-Muñoz I, Gomez-Conesa A, Sanchez-Meca J. Prevalence of low back pain in children and adolescents: A meta-analysis. BMC Pediatr 2013; 13: 14. doi: 10.1186/1471-2431-13-14.
5. Taimela S, Kujala UM, Salminen JJ, Viljanen T. The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland. Spine 1997; 22: 1132–6. doi: 10.1097/00007632-199705150-00013.
6. Lumbago [Internet] Dublin, Ireland: Medmedia Group 2015. Available from: http://www.irishhealth.com/article.html?id=577&ss=Lumbago.
7. Henschke N, Maher CG, Refshauge KM et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum 2009; 60: 3072–80.
8. Darvishi E, Maleki A, Giahi O, Akbarzadeh A. Subjective Mental Workload and Its Correlation with Musculoskeletal Disorders in Bank Staff. J Manipulative Physiol Ther 2016. pii: S0161-4754(16)30085-9. doi: 10.1016/j.jmpt.2016.05.003.
9. De Vitta A. Alombalgia e suas relações com o tipo de ocupação com a idade e o sexo. Rev Bras Fisioter 1997; 1: 67–72.
10. Heuch I, Hagen K, Heuch I et al. The impact of body mass index on the prevalence of low back pain: the HUNT study. Spine (Phila Pa 1976) 2010; 35: 764–8.
11. Chen SM, Liu MF, Cook J et al. Sedentary lifestyle as a risk factor for low back pain: a systematic review. Int Arch Occup Environ Health 2009; 82: 797–806.
12. Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine (Phila Pa 1976) 1996; 21: 2763–9.
13. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine (Phila Pa 1976) 1994; 19: 165–72.
14. Bayramoglu M, Akman MN, Kilinc S et al. Isokinetic measurement of trunk muscle strength in women with chronic low-back pain. Am J Phys Med Rehabil 2001; 80: 650–5.
15. Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: what works? Pain 2004; 107: 176–90.
16. Kotova O.V., Akarachkova E.S. Bol' v shee: rasprostranennost', faktory vozniknoveniia, vozmozhnosti terapii. Farmateka. 2014; 9: 45–9. [in Russian]
17. Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol 2010; 24: 783–92. doi: 10.1016/j.berh.2011.01.019.
18. Pool JJ, Ostelo RW, Knol D et al. Are psychological factors prognostic indicators of outcome in patients with sub-acute neck pain? Man Ther 2010; 15: 111–6. doi: 10.1016/j.math.2009.08.001.
19. Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint. Pain 1993; 55: 99–106.
20. Côté P, van der Velde G et al. Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. The burden and determinants of neck pain in workers: Results of the bone and joint decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 2008; 33 (Suppl.): 60–74.
21. De Loose V, Burnotte F, Cagnie B et al. Prevalence and risk factors of neck painin military office workers. Mil Med 2008; 173: 474–9.
22. Ariëns GA, van Mechelen W, Bongers PM et al. Physical risk factors for neck pain. Scand J Work Environ Health 2000; 26: 7–19.
23. Darivemula SB, Goswami K et al. Work-related Neck Pain Among Desk Job Workers of Tertiary Care Hospital in New Delhi, India: Burdenand Determinants. Indian J Community Med 2016; 41 (1): 50–4. doi: 10.4103/0970-0218.170967.
24. Côté P, Cassidy JD, Carroll LJ, Kristman V. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain 2004; 112 (3): 267–73.
25. Guzman J, Haldeman S, Carroll LJ et al. Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders Clinical practice implications of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations. Spine (Phila Pa 1976) 2008; 15 (33); Suppl. 4: S199–213.
26. Kotova O.V., Akarachkova E.S. Ostrye bolevye sindromy v nevrologicheskoi praktike. Effektivnaia farmakoterapiia. 2014; 31: 40–5. [in Russian]
27. Henschke N, Maher CG, Refshauge KM et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ 2008; 337: a171.
28. Van Tulder M, Becker A, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (2): 169–91.
29. Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for the aspiei-like drugs. Nature 1971; 231: 235–9.
30. Pérez-Urizar J, Granados-Soto V et al. Analgesic efficacy and bioavailability of ketorolac in postoperative pain: a probability analysis. Arch Med Res 2000; 31 (2): 191–6.
31. Veenema KR, Leahey N, Schneider S. Ketorolac versus meperidine: ED treatment of severe musculoskeletal low back pain. Am J Emerg Med 2000; 18 (4): 404–7.
32. Innes GD, Croskerry P. Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain. J Emerg Med 1998; 16 (4): 549–56.
33. Bjarnason I. Gastrointestinal safety of NSAIDs and over‐the‐counter analgesics. Int J Clin Pract 2013; 178 (Suppl.): 37–42.
34. Feldman HI, Kinman JL, Berlin JA et al. Parenteral ketorolac: the risk for acute renal failure. Ann Intern Med 1997; 126 (3): 193–9.
2. Statistical year book of the social insurance institution 2013. Kansaneläkelaitos – The Social Insurance Institution of Finland 2015. http://www.kela.fi/documents/10180/1630875/Statistical_Yearbook_of_the_Social_Insurance_Institution_....
3. Hakala P, Rimpelä A, Salminen JJ et al. M. Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys. Brit Med J 2002; 325: 743–5. doi: 10.1136/bmj.325.7367.743.
4. Calvo-Muñoz I, Gomez-Conesa A, Sanchez-Meca J. Prevalence of low back pain in children and adolescents: A meta-analysis. BMC Pediatr 2013; 13: 14. doi: 10.1186/1471-2431-13-14.
5. Taimela S, Kujala UM, Salminen JJ, Viljanen T. The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland. Spine 1997; 22: 1132–6. doi: 10.1097/00007632-199705150-00013.
6. Lumbago [Internet] Dublin, Ireland: Medmedia Group 2015. Available from: http://www.irishhealth.com/article.html?id=577&ss=Lumbago.
7. Henschke N, Maher CG, Refshauge KM et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum 2009; 60: 3072–80.
8. Darvishi E, Maleki A, Giahi O, Akbarzadeh A. Subjective Mental Workload and Its Correlation with Musculoskeletal Disorders in Bank Staff. J Manipulative Physiol Ther 2016. pii: S0161-4754(16)30085-9. doi: 10.1016/j.jmpt.2016.05.003.
9. De Vitta A. Alombalgia e suas relações com o tipo de ocupação com a idade e o sexo. Rev Bras Fisioter 1997; 1: 67–72.
10. Heuch I, Hagen K, Heuch I et al. The impact of body mass index on the prevalence of low back pain: the HUNT study. Spine (Phila Pa 1976) 2010; 35: 764–8.
11. Chen SM, Liu MF, Cook J et al. Sedentary lifestyle as a risk factor for low back pain: a systematic review. Int Arch Occup Environ Health 2009; 82: 797–806.
12. Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine (Phila Pa 1976) 1996; 21: 2763–9.
13. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine (Phila Pa 1976) 1994; 19: 165–72.
14. Bayramoglu M, Akman MN, Kilinc S et al. Isokinetic measurement of trunk muscle strength in women with chronic low-back pain. Am J Phys Med Rehabil 2001; 80: 650–5.
15. Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: what works? Pain 2004; 107: 176–90.
16. Котова О.В., Акарачкова Е.С. Боль в шее: распространенность, факторы возникновения, возможности терапии. Фарматека. 2014; 9: 45–9. / Kotova O.V., Akarachkova E.S. Bol' v shee: rasprostranennost', faktory vozniknoveniia, vozmozhnosti terapii. Farmateka. 2014; 9: 45–9. [in Russian]
17. Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol 2010; 24: 783–92. doi: 10.1016/j.berh.2011.01.019.
18. Pool JJ, Ostelo RW, Knol D et al. Are psychological factors prognostic indicators of outcome in patients with sub-acute neck pain? Man Ther 2010; 15: 111–6. doi: 10.1016/j.math.2009.08.001.
19. Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint. Pain 1993; 55: 99–106.
20. Côté P, van der Velde G et al. Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. The burden and determinants of neck pain in workers: Results of the bone and joint decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976) 2008; 33 (Suppl.): 60–74.
21. De Loose V, Burnotte F, Cagnie B et al. Prevalence and risk factors of neck painin military office workers. Mil Med 2008; 173: 474–9.
22. Ariëns GA, van Mechelen W, Bongers PM et al. Physical risk factors for neck pain. Scand J Work Environ Health 2000; 26: 7–19.
23. Darivemula SB, Goswami K et al. Work-related Neck Pain Among Desk Job Workers of Tertiary Care Hospital in New Delhi, India: Burdenand Determinants. Indian J Community Med 2016; 41 (1): 50–4. doi: 10.4103/0970-0218.170967.
24. Côté P, Cassidy JD, Carroll LJ, Kristman V. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain 2004; 112 (3): 267–73.
25. Guzman J, Haldeman S, Carroll LJ et al. Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders Clinical practice implications of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations. Spine (Phila Pa 1976) 2008; 15 (33); Suppl. 4: S199–213.
26. Котова О.В., Акарачкова Е.С. Острые болевые синдромы в неврологической практике. Эффективная фармакотерапия. 2014; 31: 40–5. / Kotova O.V., Akarachkova E.S. Ostrye bolevye sindromy v nevrologicheskoi praktike. Effektivnaia farmakoterapiia. 2014; 31: 40–5. [in Russian]
27. Henschke N, Maher CG, Refshauge KM et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ 2008; 337: a171.
28. Van Tulder M, Becker A, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (2): 169–91.
29. Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for the aspiei-like drugs. Nature 1971; 231: 235–9.
30. Pérez-Urizar J, Granados-Soto V et al. Analgesic efficacy and bioavailability of ketorolac in postoperative pain: a probability analysis. Arch Med Res 2000; 31 (2): 191–6.
31. Veenema KR, Leahey N, Schneider S. Ketorolac versus meperidine: ED treatment of severe musculoskeletal low back pain. Am J Emerg Med 2000; 18 (4): 404–7.
32. Innes GD, Croskerry P. Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain. J Emerg Med 1998; 16 (4): 549–56.
33. Bjarnason I. Gastrointestinal safety of NSAIDs and over‐the‐counter analgesics. Int J Clin Pract 2013; 178 (Suppl.): 37–42.
34. Feldman HI, Kinman JL, Berlin JA et al. Parenteral ketorolac: the risk for acute renal failure. Ann Intern Med 1997; 126 (3): 193–9.
________________________________________________
2. Statistical year book of the social insurance institution 2013. Kansaneläkelaitos – The Social Insurance Institution of Finland 2015. http://www.kela.fi/documents/10180/1630875/Statistical_Yearbook_of_the_Social_Insurance_Institution_....
3. Hakala P, Rimpelä A, Salminen JJ et al. M. Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys. Brit Med J 2002; 325: 743–5. doi: 10.1136/bmj.325.7367.743.
4. Calvo-Muñoz I, Gomez-Conesa A, Sanchez-Meca J. Prevalence of low back pain in children and adolescents: A meta-analysis. BMC Pediatr 2013; 13: 14. doi: 10.1186/1471-2431-13-14.
5. Taimela S, Kujala UM, Salminen JJ, Viljanen T. The prevalence of low back pain among children and adolescents. A nationwide, cohort-based questionnaire survey in Finland. Spine 1997; 22: 1132–6. doi: 10.1097/00007632-199705150-00013.
6. Lumbago [Internet] Dublin, Ireland: Medmedia Group 2015. Available from: http://www.irishhealth.com/article.html?id=577&ss=Lumbago.
7. Henschke N, Maher CG, Refshauge KM et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum 2009; 60: 3072–80.
8. Darvishi E, Maleki A, Giahi O, Akbarzadeh A. Subjective Mental Workload and Its Correlation with Musculoskeletal Disorders in Bank Staff. J Manipulative Physiol Ther 2016. pii: S0161-4754(16)30085-9. doi: 10.1016/j.jmpt.2016.05.003.
9. De Vitta A. Alombalgia e suas relações com o tipo de ocupação com a idade e o sexo. Rev Bras Fisioter 1997; 1: 67–72.
10. Heuch I, Hagen K, Heuch I et al. The impact of body mass index on the prevalence of low back pain: the HUNT study. Spine (Phila Pa 1976) 2010; 35: 764–8.
11. Chen SM, Liu MF, Cook J et al. Sedentary lifestyle as a risk factor for low back pain: a systematic review. Int Arch Occup Environ Health 2009; 82: 797–806.
12. Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine (Phila Pa 1976) 1996; 21: 2763–9.
13. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine (Phila Pa 1976) 1994; 19: 165–72.
14. Bayramoglu M, Akman MN, Kilinc S et al. Isokinetic measurement of trunk muscle strength in women with chronic low-back pain. Am J Phys Med Rehabil 2001; 80: 650–5.
15. Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: what works? Pain 2004; 107: 176–90.
16. Kotova O.V., Akarachkova E.S. Bol' v shee: rasprostranennost', faktory vozniknoveniia, vozmozhnosti terapii. Farmateka. 2014; 9: 45–9. [in Russian]
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Авторы
О.В.Котова
ФГБОУ ВО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
ol_kotova@mail.ru
ФГБОУ ВО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
ol_kotova@mail.ru
________________________________________________
O.V.Kotova
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
ol_kotova@mail.ru
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
ol_kotova@mail.ru
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