nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2010-97nnp-53Research ArticleLECTURESЛЕКЦИЯChronic lumbosacral pain: diagnosis and treatmentХроническая пояснично-крестцовая боль: диагностика и лечениеВахнинаН. В.VakhninaN. V.nvakhnina71@mail.ruПервый МГМУ им. И.М. СеченоваРоссияI.M. Sechenov First Moscow State Medical UniversityRussian Federation20101409201023NO3 (2010)3034Copyright © Vakhnina N.V., 20102010Вахнина Н.В.Vakhnina N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/53

The paper considers the causes and risk factors of chronic lumbosacral pain. Particular emphasis is placed on the differential diagnosis of specific and nonspecific low back pain. It analyzes in detail the efficiency of various treatment modalities for chronic low back pain in the context of evidence-based medicine and the efficacy of nonsteroidal anti-inflammatory drugs.

В статье рассматриваются причины и факторы риска хронической боли пояснично-крестцовой локализации. Особое внимание уделено дифференциальной диагностике специфической и неспецифической поясничной боли. Подробно анализируются эффективность различных методов лечения хронической боли в нижней части спины с позиций доказательной медицины, эффективность нестероидных противовоспалительных препаратов.

хроническая боль в нижней части спиныдиагностикалечениенестероидные противовоспалительные препаратыchronic low back paindiagnosistreatmentnonsteroidal anti-inflammatory drugsReferences<div><p>Shmidt C., Raspe H., Pfingsten M. et al. Back pain in the German adult population. Spine 2007;37(18):2005-11.</p><p>Pengel L.H., Herbert R.D., Maher C.G. et al. Acute low back pain: systematic review of its prognosis. BMJ 2003;327(7410):323.</p><p>Подчуфарова Е.В., Яхно Н.Н. Боль в спине. М.: ГЭОТАР-Медиа, 2010:368 с.</p><p>Waddell G. Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine 1987;12(7):632-44.</p><p>Airaksinen O., Brox J.I., Cedraschi C. et al. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;15(Suppl. 2):S192-S300.</p><p>Birbara C.A., Puopolo A.D., Munoz D.R. et al. Treatment of chronic low back pain with etoricoxib, a new cyclo-oxygenase-2 selective inhibitor: improvement in pain and disability - a randomized, placebo-controlled, 3-month trial. J Pain 2003;4(6):307-15.</p><p>Birbara C.A., Puopolo A.D., Munoz D.R. et al. Treatment of chronic low back pain with etoricoxib, a new cyclo-oxygenase-2 selective inhibitor: improvement in pain and disability - a randomized, placebo-controlled, 3-month trial. J Pain 2003;4:307-15.</p><p>Laine L., Curtis S.P., Cryer B. et al. MEDAL Steering Committee. Assesment of upper gastrointestinal safety of etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Doclofenac Arthritis Long-term (MEDAL) programm: a randomized comparison. Lancet 2007;369:465-73.</p><p>Malmstrom K., Kotey P., Cichanowitz N. et al. Analgetic efficacy of etoricoxib in primary dysmenorrheal: results of a randomized, controlled trial. Ginecol Obstet Invest 2003;56:65-9.</p><p>Malmstorm K., Sapre A., Couglin H. et al. Etoricoxib in acute pain associated with dental surgery: a randomized, double-dlind, placebo-and active comparator-controlled dose-ranging study. Clin Ther 2004;26:667-79.</p><p>Schumacher H.R., Boice J.A., Daikh D.L. et al. Randomized double blind trial of etoricoxib and indometacin in the treatment of acute gouty arthritis. BMJ 2002;324:1488-92.</p><p>Van der Heijde D., Baraf H.S., Ramus-Remus C. et al. Evaluation of the Efficacy of Etorycoxib in Ankylosing Spondilitis. Arthr Rheum 2005;52:1205-15.</p><p>Zacher J., Feldman D., Gerli R. et al. A comparison of the therapeutic efficacy and tolerability of etoricoxib and diclofenac in patients with osteoarthritis. Curr Med Res Opin 2003;19:725-36.</p><p>Curtis S.P., Ko A.T., Bolognese J.A. et al. Pooled analysis of thrombotic cardiovascular events in clinical trials of the COX-2 selective inhibitor etoricoxib. Curr Med Res Opin 2006;22:2365-74.</p><p>Maier C., Hildebrandt J., Klinger R. et al. Morphine responsiveness, efficacy and tolerability in patients with chronic non-tumor associated pain - results of a double-blind placebo- controlled trial (MONTAS). Pain 2002;97(3):223-33.</p><p>Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther 2001;81(10):1641-74.</p><p>Salerno S.M., Browning R., Jackson J.L. The effect of antidepressant treatment on chronic back pain: a meta-analy-sis. Arch Intern Med 2002;162(1):19-24.</p><p>Salzmann E., Pforringer W., Paal G. et al. Treatment of chronic low-back syndrome with tetrazepam in a placebo controlled double-blind trial. J Drug Dev 2002;4:219-28.</p><p>Van Tulder M.W., Touray T., Furlan A.D. et al. Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the cochrane collaboration. Spine 2003;28(17):1978-92.</p><p>McCleane G.J. Does Gabapentin have an analgesic effect on background, movement and referred pain? A randomised, double-blind, placebo controlled study. Pain Clinic 2003;13:103-7.</p><p>Van Tulder M.W., Ostelo R., Vlaeyen J.W. et al. Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine 2000;25(20):2688-99.</p><p>Aure O.F., Nilsen J.H., Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine 2003;28(6): 525-31; discussion 31-2.</p><p>Hagen E.M., Eriksen H.R., Ursin H. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain? Spine 2000;25(15):1973-6.</p><p>Ernst E., White A.R. Acupuncture for back pain: a metaanalysis of randomized controlled trials. Arch Intern Med 1998;158(20):2235-41.</p><p>Vad V.B., Bhat A.L., Lutz G.E. et al. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002;27(1):11-6.</p><p>Marks R.C., Houston T., Thulbourne T. Facet joint injection and facet nerve block: a randomised comparison in 86 patients with chronic low back pain. Pain 1992;49(3):325-8.</p><p>Hsieh R.L., Lee W.C. One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: comparison of therapeutic effects. Am J Phys Med Rehabil 2002;81(11):838-43.</p><p>Geurts J.W., van Wijk R.M., Stolker R.J. et al. Efficacy of radiofrequency procedures for the treatment of spinal pain: a systematic review of randomized clinical trials. Reg Anesth Pain Med 2001;26(5):394-400.</p><p>Christensen B.F., Hansen S.E., Laursen M. et al. Long-term functional outcome of pedicle screw instrumentation as a support for postero-lateral spinal fusion: randomized clinical study with a 5-year follow-up. Spine 2002;27(12):1269-77.</p><p>Delamarter R.B., Fribourg D.M., Kanim L.E. et al. ProDisc artificial total lumbar disc replacement: introduction and early results from the United States clinical trial. Spine 2003;28(20):S167-S175.</p></div><br /><div><p>Shmidt C., Raspe H., Pfingsten M. et al. Back pain in the German adult population. Spine 2007;37(18):2005-11.</p><p>Pengel L.H., Herbert R.D., Maher C.G. et al. Acute low back pain: systematic review of its prognosis. BMJ 2003;327(7410):323.</p><p>Подчуфарова Е.В., Яхно Н.Н. Боль в спине. М.: ГЭОТАР-Медиа, 2010:368 с.</p><p>Waddell G. Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine 1987;12(7):632-44.</p><p>Airaksinen O., Brox J.I., Cedraschi C. et al. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;15(Suppl. 2):S192-S300.</p><p>Birbara C.A., Puopolo A.D., Munoz D.R. et al. Treatment of chronic low back pain with etoricoxib, a new cyclo-oxygenase-2 selective inhibitor: improvement in pain and disability - a randomized, placebo-controlled, 3-month trial. J Pain 2003;4(6):307-15.</p><p>Birbara C.A., Puopolo A.D., Munoz D.R. et al. Treatment of chronic low back pain with etoricoxib, a new cyclo-oxygenase-2 selective inhibitor: improvement in pain and disability - a randomized, placebo-controlled, 3-month trial. J Pain 2003;4:307-15.</p><p>Laine L., Curtis S.P., Cryer B. et al. MEDAL Steering Committee. Assesment of upper gastrointestinal safety of etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Doclofenac Arthritis Long-term (MEDAL) programm: a randomized comparison. Lancet 2007;369:465-73.</p><p>Malmstrom K., Kotey P., Cichanowitz N. et al. Analgetic efficacy of etoricoxib in primary dysmenorrheal: results of a randomized, controlled trial. Ginecol Obstet Invest 2003;56:65-9.</p><p>Malmstorm K., Sapre A., Couglin H. et al. Etoricoxib in acute pain associated with dental surgery: a randomized, double-dlind, placebo-and active comparator-controlled dose-ranging study. Clin Ther 2004;26:667-79.</p><p>Schumacher H.R., Boice J.A., Daikh D.L. et al. Randomized double blind trial of etoricoxib and indometacin in the treatment of acute gouty arthritis. BMJ 2002;324:1488-92.</p><p>Van der Heijde D., Baraf H.S., Ramus-Remus C. et al. Evaluation of the Efficacy of Etorycoxib in Ankylosing Spondilitis. Arthr Rheum 2005;52:1205-15.</p><p>Zacher J., Feldman D., Gerli R. et al. A comparison of the therapeutic efficacy and tolerability of etoricoxib and diclofenac in patients with osteoarthritis. Curr Med Res Opin 2003;19:725-36.</p><p>Curtis S.P., Ko A.T., Bolognese J.A. et al. Pooled analysis of thrombotic cardiovascular events in clinical trials of the COX-2 selective inhibitor etoricoxib. Curr Med Res Opin 2006;22:2365-74.</p><p>Maier C., Hildebrandt J., Klinger R. et al. Morphine responsiveness, efficacy and tolerability in patients with chronic non-tumor associated pain - results of a double-blind placebo- controlled trial (MONTAS). Pain 2002;97(3):223-33.</p><p>Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther 2001;81(10):1641-74.</p><p>Salerno S.M., Browning R., Jackson J.L. The effect of antidepressant treatment on chronic back pain: a meta-analy-sis. Arch Intern Med 2002;162(1):19-24.</p><p>Salzmann E., Pforringer W., Paal G. et al. Treatment of chronic low-back syndrome with tetrazepam in a placebo controlled double-blind trial. J Drug Dev 2002;4:219-28.</p><p>Van Tulder M.W., Touray T., Furlan A.D. et al. Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the cochrane collaboration. Spine 2003;28(17):1978-92.</p><p>McCleane G.J. Does Gabapentin have an analgesic effect on background, movement and referred pain? A randomised, double-blind, placebo controlled study. Pain Clinic 2003;13:103-7.</p><p>Van Tulder M.W., Ostelo R., Vlaeyen J.W. et al. Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine 2000;25(20):2688-99.</p><p>Aure O.F., Nilsen J.H., Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine 2003;28(6): 525-31; discussion 31-2.</p><p>Hagen E.M., Eriksen H.R., Ursin H. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain? Spine 2000;25(15):1973-6.</p><p>Ernst E., White A.R. Acupuncture for back pain: a metaanalysis of randomized controlled trials. Arch Intern Med 1998;158(20):2235-41.</p><p>Vad V.B., Bhat A.L., Lutz G.E. et al. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine 2002;27(1):11-6.</p><p>Marks R.C., Houston T., Thulbourne T. Facet joint injection and facet nerve block: a randomised comparison in 86 patients with chronic low back pain. Pain 1992;49(3):325-8.</p><p>Hsieh R.L., Lee W.C. One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: comparison of therapeutic effects. Am J Phys Med Rehabil 2002;81(11):838-43.</p><p>Geurts J.W., van Wijk R.M., Stolker R.J. et al. Efficacy of radiofrequency procedures for the treatment of spinal pain: a systematic review of randomized clinical trials. Reg Anesth Pain Med 2001;26(5):394-400.</p><p>Christensen B.F., Hansen S.E., Laursen M. et al. Long-term functional outcome of pedicle screw instrumentation as a support for postero-lateral spinal fusion: randomized clinical study with a 5-year follow-up. Spine 2002;27(12):1269-77.</p><p>Delamarter R.B., Fribourg D.M., Kanim L.E. et al. ProDisc artificial total lumbar disc replacement: introduction and early results from the United States clinical trial. Spine 2003;28(20):S167-S175.</p></div><br />

The authors declare that there are no conflicts of interest present.