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Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP)

https://doi.org/10.14412/2074-2711-2019-2S-7-16

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Abstract

Examination of a patient with chronic low back pain (LBP) is aimed at eliminating its specific cause and assessing the social and psychological factors of chronic pain. The diagnosis of chronic nonspecific (musculoskeletal) LBP is based on the exclusion of a specific cause of pain, discogenic radiculopathy, and lumbar stenosis. It is advisable to identify possible pain sources: pathology of intervertebral disc pathology, facet joints, and sacroiliac joint and myofascial syndrome.

An integrated multidisciplinary approach (a high level of evidence), including therapeutic exercises, physical activity optimization, psychological treatments (cognitive behavioral therapy), an educational program (back pain school for patients), and manual therapy, is effective in treating chronic musculoskeletal LBP. For pain relief, one may use nonsteroidal anti-inflammatory drugs in minimally effective doses and in a short cycle, muscle relaxants, and a capsaicin patch, and, if there is depressive disorder, antidepressants (a medium level of evidence). Radiofrequency denervation or therapeutic blockages with anesthetics and glucocorticoids (damage to the facet joints, sacroiliac joint), back massage, and acupuncture (a low level of evidence) may be used in some patients.

Therapeutic exercises and an educational program (the prevention of excessive loads and prolonged static and uncomfortable postures and the use of correct methods for lifting weights, etc.) are recommended for preventive purposes. 

About the Authors

V. A. Parfenov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
11, Rossolimo St., Moscow 119021


N. N. Yakhno
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
11, Rossolimo St., Moscow 119021


O. S. Davydov
Z.P. Solovyev Research and Practical Center of Psychoneurology, Moscow Healthcare Department
Russian Federation
43, Donskaya St., Moscow 115419


M. L. Kukushkin
Research Institute of General Pathology and Pathophysiology, Russian Academy of Sciences
Russian Federation
8, Baltiyskaya St., Moscow 125315


M. V. Churyukanov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia; Acad. B.V. Petrovsky Russian Research Center of Surgery
Russian Federation

11, Rossolimo St., Moscow 119021;

2, Abrikosovsky Lane, Moscow 119991



V. A. Golovacheva
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
11, Rossolimo St., Moscow 119021


A. I. Isaikin
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
11, Rossolimo St., Moscow 119021


E. E. Achkasov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
11, Rossolimo St., Moscow 119021


G. Yu. Evzikov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
11, Rossolimo St., Moscow 119021


A. E. Karateev
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
34A, Kashirskoe Shosse, Moscow 115522


F. A. Khabirov
Kazan State Medical Academy, Branch, Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation
36, Butlerov St., Kazan 420012


V. A. Shirokov
Ural State Medical University, Ministry of Health of Russia
Russian Federation
35, Repin St., Yekaterinburg 620028


E. Z. Yakupov
Kazan State Medical University, Ministry of Health of Russia
Russian Federation
49, Butlerov St., Kazan 420012


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For citation:


Parfenov V.A., Yakhno N.N., Davydov O.S., Kukushkin M.L., Churyukanov M.V., Golovacheva V.A., Isaikin A.I., Achkasov E.E., Evzikov G.Y., Karateev A.E., Khabirov F.A., Shirokov V.A., Yakupov E.Z. Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2S):7-16. (In Russ.) https://doi.org/10.14412/2074-2711-2019-2S-7-16

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