Диагностика и лечение острой неспецифической пояснично-крестцовой боли
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Parfenov V.A., Golovacheva V.A. Diagnosis and treatment of acute low back pain. Therapeutic Archive. 2019; 91 (8): 155–159. DOI: 10.26442/00403660.2019.08.000315
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Ключевые слова: острая пояснично-крестцовая боль, острая боль в нижней части спины, магнитно-резонансная томография позвоночника, нестероидные противовоспалительные средства, витамины группы В, Мильгамма.
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Low back pain (LBP) is frequent cause for visit to the doctor and common cause of disability. Modern experts’ recommendations for diagnostics and treatment of acute LBP are presented. Common mistakes, difficulties in diagnostics and treatment of acute LBP are discussed. Diagnosis of non-specific acute LBP is based on clinical examination and exclusion of specific causes of back pain. Instrumental studies are not needed in most cases of acute LBP. Key steps in the treatment of patients with acute non-specific LBP are to inform of patients about good prognosis of pain, to recommend daily activity and avoidance of bed rest, to prescribe nonsteroidal anti-inflammatory drug for pain reducing. Effectiveness of vitamins B in acute LBP is discussed.
Keywords: acute low back pain, non-specific low back pain, magnetic resonance imaging of vertebra, nonsteroidal anti-inflammatory drugs, vitamins B, Milgamma.
2. Andersson GB. The epidemiology of spinal disorders. In: Frymoyer JW, editor. The adult spine: principles and practice. 2nd ed. New York: Raven Press; 1997. Р. 93-141.
3. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-96. doi: 10.1016/S0140-6736(12)61729-2
4. Подчуфарова Е.В., Яхно Н.Н. Боль в спине. М., 2010. 368 с. [Podchufarova EV, Yahno NN. Bol’ v spine [Pain in back]. Moscow, 2010. 368 p. (In Russ.)].
5. Парфенов В.А., Исайкин А.И. Боли в нижней части спины: мифы и реальность. М.: ИМА-ПРЕСС, 2016. 104 с. [Parfenov VA, Isajkin AI. Boli v nizhnej chasti spiny: mify i real'nost' [Pain in lower back: myths and reality]. Moscow: IMA-PRESS, 2016. 104 p. (In Russ.)].
6. Парфенов В.А., Исайкин А.И. Боли в поясничной области. Библиотека практического врача. М.: МЕДпрес-информ, 2018. 200 с. [Parfenov VA, Isajkin AI. Boli v poyasnichnoj oblasti. Biblioteka prakticheskogo vracha [Pain in the lumbar region. Practitioner Library]. Moscow: MEDpres-inform, 2018. 200 p. (In Russ.)].
7. Koes BW, van Tulder M, Lin CW, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19:2075-94. doi:10.1007/s00586-018-5673-2
8. Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59]. Published date: November 2016. www.nice.org.uk/guidance/ng59/evidence. doi: 10.1016/j.jphys.2017.02.012
9. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2017. doi: 10.1007/s00586-017-5099-2
10. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-30. doi: 10.7326/m16-2367
11. Парфенов В.А., Яхно Н.Н., Кукушкин М.Л. и др. Острая неспецифическая (скелетно-мышечная) поясничная боль. Рекомендации Российского общества по изучению боли (РОИБ). Неврология, нейропсихиатрия, психосоматика. 2018;9(2):4-11. [Parfenov VA, Yakhno NN, Kukushkin ML, et al. Acute nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, neuropsychiatry, psychosomatics. 2018;10(2):4-11 (In Russ.)]. doi: 10.14412/2074-2711-2018-2-4-11
12. Steffens D, Hancock MJ, Maher CG, et al. Does magnetic resonance imaging predict future low back pain? A systematic review. Еur J Pain. 2014;18(6):755-65. doi: 10.1002/j.1532-2149.2013.00427.x
13. Bardin LD, King P, Maher CG. Diagnostic triage for low back pain: a practical approach for primary care. Med J Aust. 2017;206(6):268-73. doi: 10.5694/mja16.00828
14. Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24:769-81. doi: 10.1016/j.berh.2010.10.002
15. Ash LM, Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR Am J Neuroradiol. 2008;29:1098-103. doi: 10.3174/ajnr.A0999
16. Jarvik JG, Hollingworth W, Martin B, et al. Rapid magnetic resonance imaging vs adiographs for patients with low back pain: a randomized controlled trial. JAMA. 2003;289:2810-8. doi: 10.1001/jama.289.21.2810
17. Hong J-Y, Son K-S, Cho JH, Lee JH. An Updated Overview of Low Back Pain Management in Primary Care. Asian Spine J. 2017;11(4):653-60. doi: 10.4184/asj.2017.11.4.653
18. Насонов Е.Л., Яхно Н.Н., Каратеев А.Е. и др. Общие принципы лечения скелетно-мышечной боли: междисциплинарный консенсус. Научно-практическая ревматология. 2016;54(3):247-65 [Nasonov EL, Yakhno NN, Karateev AE, et al. General principles of treatment for musculoskeletal pain: interdisciplinary consensus. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2016;54(3):247-65 (In Russ.)]. doi: 10.14412/1995-4484-2016-247-265
19. Каратеев А.Е., Алексеева Л.И., Цурган А.В., Гонтаренко Н.В. Терапия острой/подострой скелетно-мышечной боли: результаты наблюдательного исследования АЛИСА (Анальгетическое Лечение с Использованием Системного Алгоритма). Терапевтический архив. 2017;89(12-2):175-84 [Karateev AE, Alekseeva LI, Curgan AV, Gontarenko NV. Therapy for acute/subacute musculoskeletal pain: results of the ATUSA (Analgesic Treatment Using a Systemic Algorithm) observational study. Therapeutic Archive. 2017;89(12-2):175-84 (In Russ.)]. doi: 10.17116/terarkh20178912175-184
20. Каратеев А.Е., Погожева Е.Ю., Филатова Е.С. и др. Факторы, влияющие на результаты анальгетической терапии. Результаты российского многоцентрового исследования НОТА (НПВП для Обезболивания: Терапевтический Анализ). Терапевтический архив. 2018;90(6):65-73 [Karateev AE, Pogozheva EYu, Filatova ES, et al. Factors affecting the results of analgesic therapy. Results of the Russian multicentre study of NOTE (NSAID: Open-label Trial of Efficacy). Therapeutic Archive. 2018; 90(6):65-73 (In Russ.)]. doi: 10.26442/terarkh201890665-73
21. Kuritzky L, Samraj GP. Nonsteroidal anti-inflammatory drugs in the treatment of low back pain. J Pain Res. 2012;5:579-90. doi: 10.2147/jpr.s6775
22. Piccoliori G, Engl A, Gatterer D, et al. Management of low back pain in general practice – is it of acceptable quality: an observational study among 25 general practices in South Tyrol (Italy). BMC Family Pract. 2013;14:148-56. doi: 10.1186/1471-2296-14-148
23. Williams CM, Maher CG, McLachlan AJ, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014;384:1586-96. doi: 10.1016/s0140-6736(14)60805-9
24. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015 Mar 31;350:h1225. doi: 10.1136/bmj.h1225
25. Liu L, Skinner M, McDonough S, et al. Acupuncture for Low Back Pain: An Overview of Systematic Reviews. Evid Based Complement Alternat Med. 2015; ID 328196. 18 p. doi: 10.1155/2015/328196
26. Furlan AD, Giraldo M, Baskwill A, et al. Massage for low-back pain. Cochrane Database Syst Rev. 2015;CD001929. doi: 10.1155/2015/328196
27. Franca DS, Souza AL, Almeida KR, et al. B vitamins induce an antinoceceptive effect in the acetic acid and formaldehyde models of nociception in mice. Eur J Pharmacol. 2001;421(3):157-64. doi: 10.1016/s0014-2999(01)01038-x
28. Sánchez-Ramírez GM, Caram-Salas NL, Rocha-Gonzáles HI, et al. Benfotiamine relieves inflamatory and neuropathic pain in rats. Eur J Pharmacol. 2006;150(1-2):48-53. doi: 10.1016/j.ejphar.2005.11.016
29. Bartoszyk GD. The interactions of vitamins B1, B6 and B12 with non-steroidal antirheumatic and analgesic drugs: animal experiment results. Klin Wochenschr. 1990 Jan 19;68(2):121-4. doi?
30. Jurna I, Carlsson KH, Komen W, Bonke D. Acute effects of vitamin B6 and fixed combinations of vitamin B1, B6 and B12 on nociceptive activity evoked in the rat thalamus: dose–response relationship and combinations with morphine and paracetamol. Klin Wochenschr. 1990 Jan 19;68(2):129-35. doi?
31. Mibielli M, Geller M, Cohen JC, et al. Diclofenac Plus B Vitamins Versus Diclofenac Monotherapy in Lumbago: the DOLOR Study. Curr Med Res Opin. 2009;25(11):2589-99. doi: 10.3111/13696990903246911
32. Головачева В.А., Головачева А.А. Терапия острой неспецифической боли в спине: новые возможности. Неврология, нейропсихиатрия, психосоматика. 2018;10(4):123-8 [Golovacheva VA, Golovacheva AA. Therapy for acute nonspecific back pain: new additional opportunities. Neurology, Neuropsychiatry, Psychosomatics. 2018;10 (4):123-8 (In Russ.)]. doi: 10.14412/2074-2711-2018-4-123-128
33. Данилов А.Б. Лечение острой боли в спине: витамины группы «В» или НПВП? Русский медицинский журнал. 2010;0:35-40. [Danilov AB. Treatment of acute back pain: B vitamins or NSAIDs? Russkij medicinskij zhurnal. 2010;0:35-40 (In Russ.)].
34. Камчатнов П.Р. Повышение эффективности и безопасности лечения пациентов с поясничной болью. Журнал неврологии и психиатрии им. С.С. Корсакова. 2016;116(10):28-33 [Kamchatnov PR. Improvement of the efficacy and safety of the treatment of patients with low back pain. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova. 2016;116(10): 28-33 (In Russ.)]. doi: 10.17116/jnevro201611610128-33
35. Buesing S, Costa M, Schilling JM, Moeller-Bertram T. Vitamin B12 as a Treatment for Pain. Pain Phys. 2019 Jan;22(1):E45-E52. doi?
36. Steffens D, Maher CG, Pereira LS, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016;176(2):199-208. doi: 10.1001/jamainternmed.2015.7431
37. Герасимова О.Н., Парфенов В.А., Калимеева Е.Ю. Лечение пациентов с острой и подострой дорсалгией. Неврология, нейропсихиатрия, психосоматика. 2018;9(3):36-41. [Gerasimova ON, Parfenov VA, Kalimeeva EYu. Treatment of patients with acute and subacute dorsalgia. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(3):36-41 (In Russ.)]. doi: 10.14412/2074-2711-2018-3-36-41
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1. Jordan KP, Kadam UT, Hayward R, et al. Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskelet Disord. 2010;11:144. doi: 10.1186/1471-2474-11-144
2. Andersson GB. The epidemiology of spinal disorders. In: Frymoyer JW, editor. The adult spine: principles and practice. 2nd ed. New York: Raven Press; 1997. Р. 93-141.
3. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-96. doi: 10.1016/S0140-6736(12)61729-2
4. [Podchufarova EV, Yahno NN. Bol’ v spine [Pain in back]. Moscow, 2010. 368 p. (In Russ.)].
5. [Parfenov VA, Isajkin AI. Boli v nizhnej chasti spiny: mify i real'nost' [Pain in lower back: myths and reality]. Moscow: IMA-PRESS, 2016. 104 p. (In Russ.)].
6.[Parfenov VA, Isajkin AI. Boli v poyasnichnoj oblasti. Biblioteka prakticheskogo vracha [Pain in the lumbar region. Practitioner Library]. Moscow: MEDpres-inform, 2018. 200 p. (In Russ.)].
7. Koes BW, van Tulder M, Lin CW, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19:2075-94. doi:10.1007/s00586-018-5673-2
8. Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59]. Published date: November 2016. www.nice.org.uk/guidance/ng59/evidence. doi: 10.1016/j.jphys.2017.02.012
9. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2017. doi: 10.1007/s00586-017-5099-2
10. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-30. doi: 10.7326/m16-2367
11. [Parfenov VA, Yakhno NN, Kukushkin ML, et al. Acute nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, neuropsychiatry, psychosomatics. 2018;10(2):4-11 (In Russ.)]. doi: 10.14412/2074-2711-2018-2-4-11
12. Steffens D, Hancock MJ, Maher CG, et al. Does magnetic resonance imaging predict future low back pain? A systematic review. Еur J Pain. 2014;18(6):755-65. doi: 10.1002/j.1532-2149.2013.00427.x
13. Bardin LD, King P, Maher CG. Diagnostic triage for low back pain: a practical approach for primary care. Med J Aust. 2017;206(6):268-73. doi: 10.5694/mja16.00828
14. Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24:769-81. doi: 10.1016/j.berh.2010.10.002
15. Ash LM, Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR Am J Neuroradiol. 2008;29:1098-103. doi: 10.3174/ajnr.A0999
16. Jarvik JG, Hollingworth W, Martin B, et al. Rapid magnetic resonance imaging vs adiographs for patients with low back pain: a randomized controlled trial. JAMA. 2003;289:2810-8. doi: 10.1001/jama.289.21.2810
17. Hong J-Y, Son K-S, Cho JH, Lee JH. An Updated Overview of Low Back Pain Management in Primary Care. Asian Spine J. 2017;11(4):653-60. doi: 10.4184/asj.2017.11.4.653
18. [Nasonov EL, Yakhno NN, Karateev AE, et al. General principles of treatment for musculoskeletal pain: interdisciplinary consensus. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2016;54(3):247-65 (In Russ.)]. doi: 10.14412/1995-4484-2016-247-265
19. [Karateev AE, Alekseeva LI, Curgan AV, Gontarenko NV. Therapy for acute/subacute musculoskeletal pain: results of the ATUSA (Analgesic Treatment Using a Systemic Algorithm) observational study. Therapeutic Archive. 2017;89(12-2):175-84 (In Russ.)]. doi: 10.17116/terarkh20178912175-184
20. [Karateev AE, Pogozheva EYu, Filatova ES, et al. Factors affecting the results of analgesic therapy. Results of the Russian multicentre study of NOTE (NSAID: Open-label Trial of Efficacy). Therapeutic Archive. 2018; 90(6):65-73 (In Russ.)]. doi: 10.26442/terarkh201890665-73
21. Kuritzky L, Samraj GP. Nonsteroidal anti-inflammatory drugs in the treatment of low back pain. J Pain Res. 2012;5:579-90. doi: 10.2147/jpr.s6775
22. Piccoliori G, Engl A, Gatterer D, et al. Management of low back pain in general practice – is it of acceptable quality: an observational study among 25 general practices in South Tyrol (Italy). BMC Family Pract. 2013;14:148-56. doi: 10.1186/1471-2296-14-148
23. Williams CM, Maher CG, McLachlan AJ, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014;384:1586-96. doi: 10.1016/s0140-6736(14)60805-9
24. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015 Mar 31;350:h1225. doi: 10.1136/bmj.h1225
25. Liu L, Skinner M, McDonough S, et al. Acupuncture for Low Back Pain: An Overview of Systematic Reviews. Evid Based Complement Alternat Med. 2015; ID 328196. 18 p. doi: 10.1155/2015/328196
26. Furlan AD, Giraldo M, Baskwill A, et al. Massage for low-back pain. Cochrane Database Syst Rev. 2015;CD001929. doi: 10.1155/2015/328196
27. Franca DS, Souza AL, Almeida KR, et al. B vitamins induce an antinoceceptive effect in the acetic acid and formaldehyde models of nociception in mice. Eur J Pharmacol. 2001;421(3):157-64. doi: 10.1016/s0014-2999(01)01038-x
28. Sánchez-Ramírez GM, Caram-Salas NL, Rocha-Gonzáles HI, et al. Benfotiamine relieves inflamatory and neuropathic pain in rats. Eur J Pharmacol. 2006;150(1-2):48-53. doi: 10.1016/j.ejphar.2005.11.016
29. Bartoszyk GD. The interactions of vitamins B1, B6 and B12 with non-steroidal antirheumatic and analgesic drugs: animal experiment results. Klin Wochenschr. 1990 Jan 19;68(2):121-4. doi?
30. Jurna I, Carlsson KH, Komen W, Bonke D. Acute effects of vitamin B6 and fixed combinations of vitamin B1, B6 and B12 on nociceptive activity evoked in the rat thalamus: dose–response relationship and combinations with morphine and paracetamol. Klin Wochenschr. 1990 Jan 19;68(2):129-35. doi?
31. Mibielli M, Geller M, Cohen JC, et al. Diclofenac Plus B Vitamins Versus Diclofenac Monotherapy in Lumbago: the DOLOR Study. Curr Med Res Opin. 2009;25(11):2589-99. doi: 10.3111/13696990903246911
32. [Golovacheva VA, Golovacheva AA. Therapy for acute nonspecific back pain: new additional opportunities. Neurology, Neuropsychiatry, Psychosomatics. 2018;10 (4):123-8 (In Russ.)]. doi: 10.14412/2074-2711-2018-4-123-128
33. [Danilov AB. Treatment of acute back pain: B vitamins or NSAIDs? Russkij medicinskij zhurnal. 2010;0:35-40 (In Russ.)].
34. [Kamchatnov PR. Improvement of the efficacy and safety of the treatment of patients with low back pain. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova. 2016;116(10): 28-33 (In Russ.)]. doi: 10.17116/jnevro201611610128-33
35. Buesing S, Costa M, Schilling JM, Moeller-Bertram T. Vitamin B12 as a Treatment for Pain. Pain Phys. 2019 Jan;22(1):E45-E52. doi?
36. Steffens D, Maher CG, Pereira LS, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016;176(2):199-208. doi: 10.1001/jamainternmed.2015.7431
37.[Gerasimova ON, Parfenov VA, Kalimeeva EYu. Treatment of patients with acute and subacute dorsalgia. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(3):36-41 (In Russ.)]. doi: 10.14412/2074-2711-2018-3-36-41
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), кафедра нервных болезней и нейрохирургии, Москва, Россия
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V.A. Parfenov, V.A. Golovacheva
Sechenov First Moscow State Medical University (Sechenov University), Neurology and Neurosurgery Department, Moscow, Russia