Пизова Н.В. Острая и хроническая боль в нижней части спины. Неврология и Ревматология (Прил. к журн. Consilium Medicum). 2019; 1: 25–30.
DOI: 10.26442/2414357X.2019.1.190348
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Pizova N.V. Acute and chronic low back pain. Neurology and Rheumatology (Suppl. Consilium Medicum). 2019; 1: 25–30. DOI: 10.26442/2414357X.2019.1.190348
Острая и хроническая боль в нижней части спины
Пизова Н.В. Острая и хроническая боль в нижней части спины. Неврология и Ревматология (Прил. к журн. Consilium Medicum). 2019; 1: 25–30.
DOI: 10.26442/2414357X.2019.1.190348
________________________________________________
Pizova N.V. Acute and chronic low back pain. Neurology and Rheumatology (Suppl. Consilium Medicum). 2019; 1: 25–30. DOI: 10.26442/2414357X.2019.1.190348
Боль в нижней части спины (БНЧС) является одной из ведущих глобальных причин инвалидности в большинстве стран. Представлены модифицируемые и немодифицируемые факторы риска развития БНЧС. Описаны индивидуальные факторы, связанные с БНЧС, и профессиональные факторы риска. Рассмотрены причины боли в спине, которые можно условно разделить на три категории: механические, немеханические и висцеральные. Представлен алгоритм оптимальной тактики ведения пациента с болью в пояснично-крестцовой области. Даны основные направления ведения пациента с острой и хронической БНЧС, согласно принципам доказательной медицины. Отмечено, что важной задачей является максимально быстрое и эффективное купирование боли, для чего требуется назначение нестероидных противовоспалительных препаратов. Отдельное внимание уделено преимущественно селективному ингибитору циклооксигеназы 2-го типа – нимесулиду.
Ключевые слова: острая и хроническая боль в нижней части спины, факторы риска, ведение пациента, согласно принципам доказательной медицины, нестероидные противовоспалительные препараты, нимесулид.
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Low back pain (LBP) is one of the leading global causes of disability in most countries. The article provides modifiable and non-modifiable risk factors for LBP. It describes individual factors associated with LBP as well as occupational risk factors. The article considers causes of back pain which can be divided into three categories: mechanical, non-mechanical and visceral. It provides an algorithm for the optimal management of a patient with pain in the lumbosacral region. It also presents the main directions for management of a patient with acute and chronic LBP in accordance with the principles of evidence-based medicine. It is noted that an important task is the most rapid and effective relief of pain, which requires an administration of non-steroidal anti-inflammatory drugs. Special attention is paid to predominantly selective cyclooxygenase-2 inhibitor – nimesulide.
Key words: acute and chronic low back pain, risk factors, patient management, according to the principles of evidence-based medicine, nonsteroidal anti-
inflammatory drugs, nimesulide.
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________________________________________________
1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388 (10053): 1545–602. PMID: 27733282.
2. Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010; 24 (6): 769–81. PMID: 21665125.
3. Kamper SJ, Henschke N, Hestbaek L et al. Musculoskeletal pain in children and adolescents. Braz J Phys Ther 2016; 20 (3): 275–84.
4. Manchikanti L, Singh V, Falco FJ et al. Epidemiology of low back pain in adults. Neuromodulation 2014; 17 (S2): 3–10. PMID: 25395111.
5. Hoy D, March L, Brooks P. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014; 73 (6): 968–74. PMID: 24665116.
6. Gerasimova O.N., Parfenov V.A. Vedenie patsientov s bol'iu v spine v ambulatornoi praktike. Nevrologiia, psikhiatriia, psikhosomatika. 2010; 4: 65–71. [in Russian]
7. Podchufarova E.V., Iakhno N.N., Alekseev V.V. et al. Khronicheskie bolevye sindromy poiasnichno-kresttsovoi lokalizatsii: znachenie strukturnykh skeletno-myshechnykh rasstroistv i psikhologicheskikh faktorov. Bol'. 2003; 1: 38–43. [in Russian]
8. Churiukanov M.V. Mul'tidistsiplinarnye programmy lecheniia khronicheskoi boli v spine. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2013; 4: 84–7. [in Russian]
9. Bernard P. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. Cincinnati, OH: Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 1997; p. 1–12. Vol DHHS (NIOSH) Publication №97B141.
10. Dionne CE, Dunn KM, Croft PR. Does back pain prevalence really decrease with increasing age? A systematic review. Age Ageing 2006; 35 (3): 229–34.
11. Haldeman S, Kopansky-Giles D, Hurwitz EL et al. Advancements in the Management of Spine Disorders. J Manipulative Physiol Ther 2012; 26 (2): 263–80.
12. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008; 8 (1): 8–20.
13. Martin BI, Deyo RA, Mirza SK et al. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299 (6): 656–64.
14. Luo XM, Pietrobon R, Sun SX et al. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine 2004; 29 (1): 79–86.
15. National Institute of Neurological Disorders and Stroke. Accessed October 20, 2014.
16. Low Back Pain Fact Sheet. 2013 NIH Publication №15-5161. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
17. Vassilaki M, Hurwitz EL. Insights in public health: perspectives on pain in the low back and neck: global burden, epidemiology, and management. Hawaii Med J 2014; 73 (4): 122–6.
18. Hoy D, Bain C, Williams G et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012; 64 (6): 2028–37.
19. Carragee EJ. Persistent low back pain. N Engl J Med 2005; 352 (18): 1891–8.
20. Waters TR, Dick RB, Davis-Barkley J, Krieg EF. A cross-sectional study of risk factors for musculoskeletal symptoms in the workplace using data from the General Social Survey (GSS). J Occup Environ Med 2007; 49 (2): 172–84.
21. Waters TR, Dick RB, Krieg EF. Trends in Work-Related Musculoskeletal Disorders A Comparison of Risk Factors for Symptoms Using Quality of Work Life Data From the 2002 and 2006 General Social Survey. J Occup Environ Med 2011; 53 (9): 1013–24.
22. Vandergrift JL, Gold JE, Hanlon A, Punnett L. Physical and psychosocial ergonomic risk factors for low back pain in automobile manufacturing workers. Occup Environ Med 2012; 69 (1): 29–34.
23. Feyer AM, Herbison P, Williamson AM et al. The role of physical and psychological factors in occupational low back pain: a prospective cohort study. Occup Environ Med 2000; 57 (2): 116–20.
24. Milosavljevic S, Bagheri N, Vasiljev RM et al. Does daily exposure to whole-body vibration and mechanical shock relate to the prevalence of low back and neck pain in a rural workforce? Ann Occup Hyg 2012; 56 (1): 10–7.
25. Keawduangdee P, Puntumetakul R, Chatchawan U et al. Prevalence and associated risk factors of low-back pain in textile fishing net manufacturing. Hum Factors 2012; 22 (6): 562–70.
26. Tissot F, Messing K, Stock S. Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day. Ergonomics 2009; 52 (11): 1402–18.
27. Sterud T, Tynes T. Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway. Occup Environ Med 2013; 70 (5): 296–302.
28. Carragee EJ. Persistent low back pain. N Engl J Med 2005; 352 (18): 1891–8.
29. Sterud T, Tynes T. Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway. Occup Environ Med 2013; 70 (5): 296–302.
30. Urquhart DM, Kelsall HL, Hoe VCW et al. Are Psychosocial Factors Associated With Low Back Pain and Work Absence for Low Back Pain in an Occupational Cohort? Clin J Pain 2013; 29 (12): 1015–20.
31. Hoogendoorn WE, Bongers PM, de Vet HCW et al. Psychosocial work characteristics and psychological strain in relation to low-back pain. Scand J Work Environ Health 2001; 27 (4): 258–67.
32. Hoogendoorn WE, van Poppel MNM, Bongers PM et al. Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine 2000; 25 (16): 2114–25.
33. Bildt Thorbjornsson CO, Alfredsson L, Fredriksson K et al. Psychosocial and physical risk factors associated with low back pain: A 24 year follow up among women and men in a broad range of occupations. Occup Environ Med 1998; 55 (2): 84–90.
34. Jansen JP, Morgenstern H, Burdorf A. Dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain. Occup Environ Med 2004; 61 (12): 972–9.
35. Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 2000; 55 (2): 145–9.
36. Kalichman L, Hunter DJ. Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum 2007; 37 (2): 69–80.
37. Kalichman L, Li L, Kim DH et al. Facet joint osteoarthritis and low back pain in the community-based population. Spine 2008; 33 (23): 2560–5.
38. Zhang J-F, Liu C, Yu H-J et al. Degenerative changes in the interspinous ligament. Acta Orthop Traumatologica Turcica 2014; 48 (6): 661–6.
39. Kalichman L, Hodges P, Li L et al. Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spin J 2010; 19 (7): 1136–44.
40. Cooper RG, St Clair Forbes W, Jayson MIV. Radiographic demonstration of paraspinal muscle wasting in patients with chronic low back pain. Rheumatology 1992; 31 (6): 389–94.
41. Demoulin C, Crielaard J-M, Vanderthommen M. Spinal muscle evaluation in healthy individuals and low-back-pain patients: a literature review. Joint Bone Spine 2007; 74 (1): 9–13.
42. McLoughlin RF, D’Arcy EM, Brittain MM et al. The significance of fat and muscle areas in the lumbar paraspinal space: a CT study. J Comput Assist Tomogr 1994; 18 (2): 275–8.
43. Chakera TM, McCormick CC. Radiology and low back pain. Aust Fam Physician 1995; 24 (4): 576–82.
44. Cypress BK. Characteristics of physician visits for back symptoms: a national perspective. Am J Public Health 1983; 73 (4): 389–95.
45. Kjaer P, Bendix T, Sorensen JS et al. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Medicine 2007; 5: 2.
46. Kindler LL, Jones KD, Perrin N et al. Risk factors predicting the development of widespread pain from chronic back or neck pain. J Pain 2010; 11: 1320–8.
47. Noormohammadpour P, Mansournia MA, Asadi-Lari M et al. A subtle threat to urban populations in developing countries: low back pain and its related risk factors. Spine 2016; 4127: 618.
48. Paksaichol A, Janwantanakul P, Purepong N et al. Office workers’ risk factors for the development of non-specific neck pain: a systematic review of prospective cohort studies. Occup Environ Med 2012; 69: 610–8.
49. Yang H, Hitchcock E, Haldeman S et al. Workplace psychosocial and organizational factors for neck pain in workers in the United States. Am J Ind Med 2016; 59: 549–60.
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Авторы
Н.В. Пизова
ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава России, Ярославль, Россия