Back pain: diagnostic and differential aspects
Abstract
Management of patients with back pain is an interdisciplinary problem requiring a package of diagnostic and differential measures. Despite the elaboration of algorithms for the differential diagnosis and therapy of back pain, a number of questions remain difficult to interpret, which can lead to diagnostic errors. This review considers the main causes of back pain and the principles of their diagnosis and treatment. It gives data from studies of therapy for nonspecific back pain with nonsteroidal anti-inflammatory drugs and muscle relaxants, aceclofenac and tolperisone in particular.
About the Author
E. G. Mendelevich
Department of Neurology and Rehabilitation, Kazan State Medical University, Ministry of Health of Russia
Russian Federation
49, Butlerov Str., Kazan 420012
Russian Federation
49, Butlerov Str., Kazan 420012
References
1. Stubbs B, Koyanagi A, Thompson T, et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: data from 43 low- and middle-income countries. Gen Hosp Psychiatry. 2016 Nov - Dec;43:63-70. doi: 10.1016/j.genhosppsych.2016.09.008. Epub 2016 Sep 30.
2. Clark S, Horton R. Low Back Pain: A Major Global Challenge. Lancet. 2018 Jun 9; 391(10137):2302. doi: 10.1016/S0140-6736(18)30725-6. Epub 2018 Mar 21.
3. Meucci R, Fassa A, Faria N. Prevalence of Chronic Low Back Pain: Systematic Review. Rev Saude Publica. 2015;49. pii: S0034-89102015000100408. doi: 10.1590/S0034-8910.2015049005874. Epub 2015 Oct 20.
4. 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 Oct 8;388(10053):1545-1602. doi: 10.1016/S0140-6736(16)31678-6.
5. Chenot J, Greitemann B, Kladny B, et al. Non-Specific Low Back Pain (On behalf of the National Care Guideline development group for non-specific back pain ). Dtsch Arztebl Int. 2017 Dec 25;114(51-52):883-890. doi: 10.3238/arztebl.2017.0883.
6. Tavee J, Levin K. Low Back Pain. Continuum (Minneap Minn). 2017 Apr;23(2, Selected Topics in Outpatient Neurology):467-486. doi: 10.1212/CON.0000000000000449.
7. Oliveira C, Maher C, Pinto R. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11): 2791-2803. doi: 10.1007/s00586-018-5673-2. Epub 2018 Jul 3.
8. Woolf A, Pleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-56. Epub 2003 Nov 14.
9. Van Tulder M, Becker A, Bekkering T. et al. Chapter 3 European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006 Mar;15 Suppl 2:S1 69-91. doi: 10.1007/s00586-006-1071-2.
10. Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord. 2017 May 12;18(1):188. doi: 10.1186/s12891-017-1549-6.
11. Handa R. Low back pain-myths and facts. J Clin Orthop Trauma. 2019 Jul-Aug;10(4): 828-830. doi: 10.1016/j.jcot.2019.05.024. Epub 2019 May 29.
12. Roman I, Luyten M, Croonenborghs H, et al. Relating the Diers formetric measurements with the subjective severity of acute and chronic low back pain. Med Hypotheses. 2019 Sep 4;133:109390. doi: 10.1016/j.mehy.2019.109390. [Epub ahead of print]
13. 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.
14. Park E, Moon S, Suh H, et al. Disc degeneration induces a mechano-sensitization of disc afferent nerve fibers that associates with low back pain. Osteoarthritis Cartilage. 2019 Nov;27(11): 1608-1617. doi: 10.1016/j.joca.2019.07.010. Epub 2019 Jul 19.
15. Kalichman L, Cole R, Kim D, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009 Jul; 9(7):545-50. doi: 10.1016/j.spinee.2009.03.005. Epub 2009 Apr 23.
16. Tomkins-Lane C, Melloh M, Smuck M, et al. Consensus on the clinical diagnosis of lumbar spinal stenosis: Results of an International Delphi Study. Spine (Phila Pa 1976). 2016 Aug 1;41(15):1239-46. doi: 10.1097/BRS.0000000000001476.
17. Haig A, Tong H, Yamakawa K, et al. Spinal stenosis, back pain, or no symptoms at all? A masked study comparing radiologic and electrodiagnostic diagnoses to the clinical impression. Arch Phys Med Rehabil. 2006 Jul;87(7): 897-903. doi: 10.1016/j.apmr.2006.03.016.
18. De Schepper E, Overdevest G, Suri P, et al. Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976). 2013 Apr 15;38(8): E469-81. doi: 10.1097/BRS.0b013e31828935ac.
19. Cook C, Brown C, Michael K, et al. The clinical value of a cluster of patient history and observational findings as a diagnostic support tool for lumbar spine stenosis. Physiother Res Int. 2011 Sep;16(3):170-8. doi: 10.1002/pri.500. Epub 2010 Nov 11.
20. Cook C, Cook C, Reiman M, et al. Systematic review of diagnostic accuracy of patient history, clinical findings, and physical tests in the diagnosis of lumbar spinal stenosis. Eur Spine J. 2019 Jul 16. doi: 10.1007/s00586-019-06048-4. [Epub ahead of print]
21. Ishimotoy N, Yoshimuraz S, Murakiz H, et al. Associations between radiographic lumbar spinal stenosis and clinical symptomsin the general population: the Wakayama Spine. Osteoarthritis Cartilage. 2013 Jun;21(6):783-8. doi: 10.1016/j.joca.2013.02.656. Epub 2013 Mar 5.
22. Mendelevich EG, Davletshina RI, Valieva LK. Clinical and neurovisual features of syringomyelia, manifested in various age periods. Nevrologicheskii vestnik. 2012;(4):45-51. (In Russ.)
23. Mendelevich EG. The acute debut of syringomyelia. Kazanskii meditsinskii zhurnal. 2002;(1):64-5. (In Russ.)
24. Roser F, Ebner F, Sixt C, et al. Defining the line between hydromyelia and syringomyelia. A differentiation is possible based on electrophysiological and magnetic resonance imaging studies. Acta Neurochir (Wien). 2010 Feb;152(2): 213-9; discussion 219. doi: 10.1007/s00701-009-0427-x. Epub 2009 Jun 16.
25. O'Connell N, Cook C, Wand B, et al. Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines. Best Pract Res Clin Rheumatol. 2016 Dec;30(6):968-980. doi: 10.1016/j.berh.2017.05.001. Epub 2017 Jun 9.
26. Meroni R, Piscitelli D, Ravasio C, et al. Evidence for managing chronic low back pain in primary care: a review of recommendations from high-quality clinical practice guidelines. Disabil Rehabil. 2019 Aug 1:1-15. doi: 10.1080/09638288.2019.1645888. [Epub ahead of print]
27. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017 Feb 18;389(10070):736-747. doi: 10.1016/S0140-6736(16)30970-9. Epub 2016 Oct 11.
28. Saraf S, Singh D, Garg G, et al. Aceclofenac: a patent non-steroidal antiinflammatory drug in latest reviews. Latest Rev. 2006;4(3):119-24.
29. Dahiya S, Kaushik A, Pathak K. Improved Pharmacokinetics of Aceclofenac Immediate Release Tablets Incorporating its Inclusion Complex with Hydroxypropyl-β-Cyclodextrin. Sci Pharm. 2015 Feb 2;83(3):501-10. doi: 10.3797/scipharm.1509-07. Print 2015 Jul-Sep.
30. Dooley M, Spencer C, Dunn C. Aceclofenac: a reappraisal of its use in the management of pain and rheumatic disease. Drugs. 2001;61(9):1351-78. doi: 10.2165/00003495-200161090-00012.
31. Wood S, Fitzpatrik K, Brodie R, et al. Pharmacokinetics and metabolism a new NSAID/analgesic aceclofenac in man. Pharm Res. 1990;7(9):212.
32. Nasonova V.A. Aceclofenac (aertal) in rheumatological practice. Terapevticheskii arkhiv. 2005;(5):87–90. (In Russ.)
33. Raber A, Heras J, Costa J, et al. Incidence of spontaneous notifications of adverse reactions with aceclofenac, meloxicam, and rofecoxib during the first year after marketing in the United Kingdom. Ther Clin Risk Manag. 2007 Jun;3(2):225-30.
34. Schattenkirchner M, Milachowsk K. A double-blind, multi-center clinical trial compuring the efficacy and tolerability of ace-clofenac with diclofenac – resinate in patients with acute low back pain. Clin Rheumatol. 2003 May;22(2): 127-35.
35. Patel P, Patel T. Efficacy and safety of aceclofenac in osteoarthritis: A meta-analysis of randomized controlled trials. Eur J Rheumatol. 2017 Mar;4(1):11-18. doi: 10.5152/eurjrheum.2017.160080. Epub 2017 Mar 1.
36. Gontarenko NV, Tsurgan AV, Karateev AE. Treatment for acute/subacute musculoskeletal pain, by using an algorithm for stepwise choice of analgesic drugs and for monitoring their efficacy: preliminary data of the analgesic treatment using systemic algorithm (ATUSA) program. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2016;10(4): 35–40. (In Russ.) doi: 10.14412/1996-7012-2016-4-35-40
37. Pareek A, Chandurkar N. Comparison of gastrointestinal safety and tolerability of aceclofenac with diclofenac: a multicenter, randomized, double-blind study in patients with knee osteoarthritis. Curr Med Res Opin. 2013 Jul;29(7):849-59. doi: 10.1185/03007995.2013.795139. Epub 2013 Apr 30.
38. Peris F, Bird HA, Serni U, et al. Treatment compliance and safety of aceclofenac versus NSAIDs in patients with common arthritis disorders: a meta-analysis. Eur Rheumatol Inflamm. 1996;16:37-45.
39. Yang JH, Suk KS, Lee BH, et al. Efficacy and Safety of Different Aceclofenac Treatments for Chronic Lower Back Pain: Prospective, Randomized, Single Center, Open-Label Clinical Trials. Yonsei Med J. 2017 May;58(3): 637-643. doi: 10.3349/ymj.2017.58.3.637.
40. Van Tulder M, Touray T, Furlan A, et al; Cochrane Back Review Group. Muscle relaxants for nonspecific low back pain: A systematic review within the framework of the cochrane collaborationSpine (Phila Pa 1976). 2003 Sep 1; 28(17):1978-92. doi: 10.1097/01.BRS.0000090503.38830.AD.
41. Morikawa K, Oshita M, Yamazaki M, et al. Pharmacological studies of the new centrally acting muscle relaxant 4'-ethyl-2-methyl-3-pyrrolidinopropiophenone hydrochloride. Arzneimittelforschung. 1987 Mar;37(3):331-6.
42. Tekes K. Basic aspects of the pharmacodynamics of tolperisone, a widely applicable centrally acting muscle relaxant. Open Med Chem J. 2014 Jul 11;8:17-22. doi: 10.2174/1874104501408010017. eCollection 2014.
43. Pratzel H, Alken R, Ramm S. Efficacy and tolerance of repeated oral doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebocontrolled double- blind trial. Pain. 1996 Oct; 67(2-3):417-25.
44. Rao R, Panghate A, Chandanwale A, et al. Clinical comparative study: efficacy and tolerability of tolperisone and thiocol chicoside in acute low back pain and spinal muscle spasticity. Asian Spine J. 2012 Jun;6(2):115-22. doi: 10.4184/asj.2012.6.2.115. Epub 2012 May 31.
45. Kukushkin ML, Brylev LV, Laskov VB, et al. Results of a randomized double blind parallel study on the efficacy and safety of tolpersione in patients with acute nonspecific low back pain. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017; 117(11):69-78. (In Russ.)
46. Chiba L, Zhussupova A, Likhachev S, et al. A systematic review of using myorelaxants in treatment of low back pain. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2018;118(12): 100-13. (In Russ.)
For citation:
Mendelevich E.G. Back pain: diagnostic and differential aspects. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(4):130-135. (In Russ.) https://doi.org/10.14412/2074-2711-2019-4-130-135
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