nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2018-2-4-11nnp-877Research ArticleCLINICAL GUIDELINESКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИAcute nonspecific (musculoskeletal) low back pain Guidelines of the Russian Society for the Study of Pain (RSSP)Острая неспецифическая (скелетно-мышечная) поясничная боль. Рекомендации РоссийскогоПарфеновВ. А.ParfenovV. A.ЯхноН. Н.YakhnoN. N.КукушкинМ. Л.KukushkinM. L.ЧурюкановМ. В.ChuryukanovM. V.ДавыдовО. С.DavydovO. S.ГоловачеваВ. А.GolovachevaV. A.

Контакты: Вероника Александровна Головачева

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xoxo.veronicka@gmail.comИсайкинА. И.IsaikinA. I.АчкасовЕ. Е.AchkasovE. E.ЕвзиковГ. Ю.EvzikovG. Yu.КаратеевА. Е.KarateevA. E.ХабировФ. А.KhabirovF. A.ШироковВ. А.ShirokovV. A.ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)» Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of RussiaRussian FederationФГБНУ «НИИ общей патологии и патофизиологии» РАНРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia; Research Institute of General Pathology and Pathophysiology, Russian Academy of SciencesRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)» Минздрава России; ФГБНУ «Российский научный центр хирургии им. акад. Б.В. Петровского»РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia; Acad. B.V. Petrovsky Russian Research Center of SurgeryRussian FederationГБУЗ «Научно-практический психоневрологический центр им. З.П. Соловьева Департамента здравоохранения города Москвы»РоссияZ.P. Solovyov Research and Practical Center of Psychoneurology, Moscow Healthcare DepartmentRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationКазанская государственная медицинская академия – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияKazan State Medical Academy, Branch, Russian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaRussian FederationФГБОУ ВО «Уральский государственный медицинский университет» Минздрава РоссииРоссияUral State Medical University, Ministry of Health of RussiaRussian Federation201823062018102411Copyright © Parfenov V.A., Yakhno N.N., Kukushkin M.L., Churyukanov M.V., Davydov O.S., Golovacheva V.A., Isaikin A.I., Achkasov E.E., Evzikov G.Y., Karateev A.E., Khabirov F.A., Shirokov V.A., 20182018Парфенов В.А., Яхно Н.Н., Кукушкин М.Л., Чурюканов М.В., Давыдов О.С., Головачева В.А., Исайкин А.И., Ачкасов Е.Е., Евзиков Г.Ю., Каратеев А.Е., Хабиров Ф.А., Широков В.А.Parfenov V.A., Yakhno N.N., Kukushkin M.L., Churyukanov M.V., Davydov O.S., Golovacheva V.A., Isaikin A.I., Achkasov E.E., Evzikov G.Y., Karateev A.E., Khabirov F.A., Shirokov V.A.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/877

The examination of a patient with acute low back pain (LBP) includes the clarification of complaints and history data, brief physical and neurological examinations, and an assessment of danger symptoms. The diagnosis of acute nonspecific (musculoskeletal) LBP is based on the exclusion of a specific cause of pain (a potentially dangerous disease), discogenic radiculopathy, and lumbar spinal stenosis. If there is typical musculoskeletal pain and no danger symptoms, radiography, X-ray computed tomography, and magnetic resonance imaging are not recommended in the first 4 weeks of disease. Whether it is expedient to perform these techniques is considered when LBP persists over this time period. A patient with acute nonspecific (musculoskeletal) LBP should be informed about the favorable outcome of the disease and the need to maintain physical and social activities, to avoid bed rest, and, if possible, to continue professional activities. The lowest effective dose of nonsteroidal anti-inflammatory drugs for short-term duration, as well as muscle relaxants (the medium level of evidence) can be used to relieve pain. It is recommended that one should use an educational program (to prevent over-exercising and prolonged standing or sitting in static and awkward positions; to lift weights properly; etc.) to prevent recurrent LBP, as well as therapeutic exercises during a non-exacerbation period.

У пациента с острой поясничной болью (ПБ) проводят оценку жалоб и данных анамнеза, краткое соматическое и неврологическое обследование, определяют наличие симптомов опасности. Диагноз острой неспецифической (скелетно-мышечной) ПБ основывается на исключении специфической причины боли (потенциально опасного заболевания), дискогенной радикулопатии и поясничного стеноза. В случаях типичной скелетно-мышечной боли, отсутствия симптомов опасности не рекомендуются проведение рентгенографии, рентгеновской компьютерной томографии, магнитно-резонансной томографии в первые 4 нед заболевания. Целесообразность их выполнения рассматривается при сохранении ПБ сверх этого времени. Пациент с острой неспецифической (скелетно-мышечной) ПБ должен быть проинформирован о благоприятном исходе заболевания, необходимости сохранять физическую и социальную активность, избегать постельного режима, при возможности продолжать профессиональную деятельность. Для облегчения боли можно использовать нестероидные противовоспалительные препараты в минимально эффективных дозах и коротким курсом, а также миорелаксанты (средний уровень доказательности). Части пациентов целесообразно назначить мануальную терапию и массаж спины (низкий уровень доказательности). Для предупреждения рецидивов ПБ рекомендуются образовательная программа (профилактика чрезмерных нагрузок, длительного пребывания в статических и неудобных позах, правильные способы подъема тяжестей и др.) и вне периода обострения – лечебная гимнастика. 

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