Боль в спине как частая причина обращения к специалисту в амбулаторных условиях
Боль в спине как частая причина обращения к специалисту в амбулаторных условиях
Пизова Н.В. Боль в спине как частая причина обращения к специалисту в амбулаторных условиях. Неврология и Ревматология (Прил. к журн. Consilium Medicum). 2018; 1: 5–9. DOI: 10.26442/2414-357X_2018.1.5-9
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Pizova N.V. Back pain as a common reason for visiting a specialist on an outpatient basis. Neurology and Rheumatology (Suppl. Consilium Medicum). 2018; 1: 5–9. DOI: 10.26442/2414-357X_2018.1.5-9
Боль в спине как частая причина обращения к специалисту в амбулаторных условиях
Пизова Н.В. Боль в спине как частая причина обращения к специалисту в амбулаторных условиях. Неврология и Ревматология (Прил. к журн. Consilium Medicum). 2018; 1: 5–9. DOI: 10.26442/2414-357X_2018.1.5-9
________________________________________________
Pizova N.V. Back pain as a common reason for visiting a specialist on an outpatient basis. Neurology and Rheumatology (Suppl. Consilium Medicum). 2018; 1: 5–9. DOI: 10.26442/2414-357X_2018.1.5-9
В статье рассмотрены вопросы острых и хронических болей в спине, причины их возникновения, основные патогенетические механизмы их формирования. Представлены часто встречаемые причины болевого синдрома. Дана характеристика ноцицептивной, нейропатической и психогенной боли в спине. Описаны комплексы «красных и желтых флажков», требующих особого внимания со стороны практикующего врача. Представлены алгоритмы диагностики боли в спине. Описана тактика ведения пациента с острой и хронической болью в спине, основанная на принципах доказательной медицины. Отдельное внимание отведено месту препарата флупиртин в терапии болевого синдрома.
Ключевые слова: острая и хроническая боль в спине, диагностика, лечение, флупиртин.
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In the article the questions of acute and chronic back pain, the causes of their origin, the main pathogenetic mechanisms of their formation are considered. The frequent causes of pain syndrome are presented. The characteristic of nociceptive, neuropathic and psychogenic pain in the back is given. The complexes of "red and yellow flags" are described, requiring special attention from the practitioner. Algorithms for the diagnosis of pain in the back are presented. The tactics of managing a patient with acute and chronic back pain is described, based on the principles of evidence-based medicine. Separate attention is given to the place of the drug flupirtine in the therapy of pain syndrome.
Key words: acute and chronic back pain, diagnosis, treatment, flupirtine.
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23. Kornhuber J, Bleich S, Wiltfang J et al. Flupirtine shows functional NMDA receptor antagonism by enhancing Mg2+ block via activation of voltage independent potassium channels. J Neural Transm 1999; 106 (9–10): 857–67.
24. Szelenyi I, Nickel B, Borbe HO, Brune H. Mode of antinociceptive action on flupirtine in the rats. Br J Pharmacol 1989; 97: 835–42.
25. Bleyer H, Carlsson KH, Erkel HJ, Jurna I. Flupirtine depresses nociceptive activity evoked in rat thalamus. Eur J Pharmacol 1988; 151 (2): 259–65.
26. Carlsson KH, Jurna I. Depression by flupirtine, a novel analgesic agent, of motor and sensory responses of the nociceptive system in the rat spinal cord. Eur J Pharmacol 1987; 143 (1): 89–99.
27. Weiser T, Szelenyi I, Nickel B, Weinrich M. In vitro and in vivo findings about the muscle relaxing properties of flupirine. Naunyn-Schmiedeberg's Arch Pharmacol 1992; 246 (Suppl. 1): R22.
28. Jurna I, Nickel B, Lobisch M et al. Analgetisch und mioralaxierend: Flupirtine. Pharmazie 1992; 137 (35): 24–32.
29. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study. Fortschr Med Orig 2003; 121 (1): 11–8.
30. Uberall MA, Mueller-Schwefe GH, Terhaag B. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study. Curr Med Res Opin 2012; 28 (10): 1617–34.
31. Wörz R. Longterm treatment of chronic pain patients with flupirtine on hepatotoxicity and persistent effectiveness from 7 months to 22 years. MMW Fortschr Med 2014; 156 (Suppl. 4): 127–34.
________________________________________________
1. Mostagi FQ, Dias JM, Pereira LM et al. Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects. Bodyw Mov Ther 2015; 19 (4): 636–45.
2. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010; 10 (6): 514–29.
3. Shmagel A, Foley R, Ibrahim H. Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009-2010 National Health and Nutrition Examination Survey. Arthritis Care Res (Hoboken) 2016; 68 (11): 1688–94.
4. Smart KM, Blake C, Staines A et al. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain. Man Ther 2012; 17 (4): 336–44.
5. Shtok V.P., Levin O.S. Spravochnik po formulirovaniiu klinicheskogo diagnoza boleznei nervnoi sistemy. M.: MIA, 2006. [in Russian]
6. Kaplan W, Wirtz V, Mantel-Teeuwisse A et al. Priority medicines for Europe and the World: 2013 upd ate. World Health Organization: Geneva, Switzerland, 2013. http://www.who.int/medicines/areas/priority_medicines/Master DocJune28_FINAL_Web.pdf.
7. Morozova O.G., Iaroshevskii A.A. Neiropaticheskaia bol': vzgliad nevrologa. Novosti meditsiny i farmatsii. Nevrologiia. 2010; 339. [in Russian]
8. Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest 2010; 120 (11): 3760–72.
9. Nijs J, Malfliet A, Ickmans K et al. Exp Opin Pharmacother 2014; 15 (12): 1671–83.
10. Podchufarova E. Bol' v spine: mekhanizmy razvitiia i lechenie. Sovr. terapiia v psikhiatrii i nevrologii. 2012; 3: 47–53. [in Russian]
11. Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical course of non-specific low back pain: A systematic review of prospective cohort studies se t in primary care. Eur J Pain 2013; 17: 5–15.
12. Parfenov V.A. Vrachebnaia taktika pri boliakh v nizhnei chasti spiny. Med. sovet. 2016; 8: 76–80. [in Russian]
13. Oren O, Ablin J. Precision medicine: the emerging approach to the chronic pain patient. Int J Clin Rheumtol 2013; 4: 491–9.
14. Bol': rukovodstvo dlia vrachei i studentov. Pod red. akad. RAMN N.N.Iakhno. M.: MEDpress-inform, 2009. [in Russian]
15. Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med 2001; 51 (2): 124–35.
16. Hepguler S. Neuropathic component of low back pain. Minimally Invasive Spine Surgery: Current Aspects 2015; 8: 229–45.
17. Erdes Sh.F. i dr. Nespetsificheskaia bol' v nizhnei chasti spiny. Klinicheskie rekomendatsii dlia uchastkovykh terapevtov i vrachei obshchei praktiki. M.: KomplektServis, 2008. [in Russian]
18. Van Tulder M.Becker А, 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.
19. Kinkade S. Evaluation and Treatment of Acute Low Back Pain. Am Fam Physician 2007; 75 (8): 1181–8.
20. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010; 4: 810–33.
21. Worz R, Mueller-Schwefe G, Stroehmann I et al. Back pain: Guidelines for drug therapy. Fortschr Med 2000; 142 (5): 27–33.
22. http://instrukciya-otzyvy.ru/1432-nolodatak-po-primeneniyu-analogi-kapsuly-tabletki-golovnaya-bol-me...
23. Kornhuber J, Bleich S, Wiltfang J et al. Flupirtine shows functional NMDA receptor antagonism by enhancing Mg2+ block via activation of voltage independent potassium channels. J Neural Transm 1999; 106 (9–10): 857–67.
24. Szelenyi I, Nickel B, Borbe HO, Brune H. Mode of antinociceptive action on flupirtine in the rats. Br J Pharmacol 1989; 97: 835–42.
25. Bleyer H, Carlsson KH, Erkel HJ, Jurna I. Flupirtine depresses nociceptive activity evoked in rat thalamus. Eur J Pharmacol 1988; 151 (2): 259–65.
26. Carlsson KH, Jurna I. Depression by flupirtine, a novel analgesic agent, of motor and sensory responses of the nociceptive system in the rat spinal cord. Eur J Pharmacol 1987; 143 (1): 89–99.
27. Weiser T, Szelenyi I, Nickel B, Weinrich M. In vitro and in vivo findings about the muscle relaxing properties of flupirine. Naunyn-Schmiedeberg's Arch Pharmacol 1992; 246 (Suppl. 1): R22.
28. Jurna I, Nickel B, Lobisch M et al. Analgetisch und mioralaxierend: Flupirtine. Pharmazie 1992; 137 (35): 24–32.
29. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study. Fortschr Med Orig 2003; 121 (1): 11–8.
30. Uberall MA, Mueller-Schwefe GH, Terhaag B. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study. Curr Med Res Opin 2012; 28 (10): 1617–34.
31. Wörz R. Longterm treatment of chronic pain patients with flupirtine on hepatotoxicity and persistent effectiveness from 7 months to 22 years. MMW Fortschr Med 2014; 156 (Suppl. 4): 127–34.
Авторы
Н.В.Пизова*
ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава России. 150000, Россия, Ярославль, ул. Революционная, д. 5
Yaroslavl State Medical University of the Ministry of Health of the Russian Federation. 150000, Russian Federation, Yaroslavl, ul. Revoliutsionnaia, d. 5