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Discogenic lumbosacral radiculopathy. Recommendations of the Russian Association for the Study of Pain (RSSP)

https://doi.org/10.14412/2074-2711-2020-4-15-24

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Abstract

When examining a patient with lumbosacral pain, it is necessary to rule out the specific cause of the disease. The diagnosis of discogenic lumbosacral radiculopathy (DLSR) is based on clinical examination; magnetic resonance imaging (MRI) is of informative value in excluding other causes of radiculopathy and in evaluating disk herniation. If the signs of cauda equina and spinal cord compression are absent, and no epidural glucocorticoid injection or urgent surgical treatment is scheduled, there is no reason for early (within the first 4 weeks) MRI.
It is recommended to inform the patient with DLSR about the possibility of disk herniation regression and natural recovery and about the advisability of maintaining physical activity. Epidural administration of local anesthetics and glucocorticoids and use of non-steroidal anti-inflammatory drugs are advisable to relieve acute pain. Anticonvulsants (pregabalin and gabapentin), muscle relaxants, and B vitamins can be used as additional methods for acute DLSR; psychological therapies (cognitive behavioral therapy), antidepressants, therapeutic exercises (kinesiotherapy), manual therapy, and acupuncture are effective in chronic DLSR. Consultation with a neurosurgeon for possible microdiscectomy is indicated in the presence of cauda equina syndrome (urgently) and in the absence of medical therapy effects within 4–8 weeks.
Therapeutic exercises (kinesitherapy) with an educational program for prevention of strenuous physical activity and static and uncomfortable positions for a long time, as well as for teaching how to lift weights properly, 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

Vladimir Anatolyevich Parfenov

8, Trubetskaya St., Build. 2, Moscow 119991



N. N. Yakhno
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991


O. S. Davydov
Research Institute for General Pathology and Pathophysiology
Russian Federation
8, Baltiyskaya St., Moscow 125315


M. L. Kukushkin
Research Institute for General Pathology and Pathophysiology
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; Academician B.V. Petrovsky Russian Research Center of Surgery
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991
2, Abrikosovskiy Lane, Moscow 119991


V. A. Golovacheva
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991


G. Yu. Evzikov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991


A. I. Isaikin
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991


M. A. Ivanova
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991


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


A. V. Amelin
Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation
6-8, Lev Tolstoy St., Saint Petersburg 197022


E. E. Achkasov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991


L. R. Akhmadeeva
Bashkir State Medical University, Ministry of Health of Russia
Russian Federation
3, Lenin St., Ufa 450008


M. A. Bakhtadze
N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Russian Federation
1, Ostrovityanov St., Moscow 117997


E. R. Barantsevich
Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation
6-8, Lev Tolstoy St., Saint Petersburg 197022


A. E. Barulin
Volgograd State Medical University, Ministry of Health of Russia
Russian Federation
1, Pavshikh Bortsov Square, Volgograd 400131


A. N. Belova
Volga Research Medical University, Ministry of Health of Russia
Russian Federation
10/1, Minin and Pozharsky Sq., Nizhny Novgorod 603005


G. N. Belskaya
Research Center of Neurology, Ministry of Education and Science of Russia
Russian Federation
80, Volokolamskoe Shosse, Moscow 125367


V. G. Bychenko
Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Russian Federation
4, Academician Oparin St., Moscow 117997


O. B. Doronina
Novosibirsk State Medical University, Ministry of Health of Russia
Russian Federation
52, Krasnyi Prospect, Novosibirsk 630091


O. N. Dreval
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation
2/1, Barrikadnaya St., Build. 1, Moscow 125993


O. I. Zagorulko
Academician B.V. Petrovsky Russian Research Center of Surgery
Russian Federation
2, Abrikosovskiy Lane, Moscow 119991


E. D. Isagulyan
Academician N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of Russia
Russian Federation
16, 4th Tverskaya-Yamskaya St., Build. 5, Moscow 125047


D. A. Iskra
Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia
Russian Federation
2, Litovskaya St., Petersburg 194100


P. P. Kalinsky
Pacific State Medical University, Ministry of Health of Russia
Russian Federation
2; Ostryakov Prospect, Vladivostok 690002


Yu. V. Karakulova
Academician E.A. Vagner Perm State Medical University, Ministry of Health of Russia
Russian Federation
26, Petropavlovskaya St., Perm 614990


O. V. Kurushina
Volgograd State Medical University, Ministry of Health of Russia
Russian Federation
1, Pavshikh Bortsov Square, Volgograd 400131


L. A. Medvedeva
Academician B.V. Petrovsky Russian Research Center of Surgery
Russian Federation
2, Abrikosovskiy Lane, Moscow 119991


D. M. Merkulova
B.M. Gekht Neurology Center
Russian Federation
2, Budayskaya St., Build. 4, Moscow 129128


A. P. Rachin
National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia
Russian Federation
32; Novyi Arbat St., Moscow 121099


D. A. Sergienko
South Ural State Medical University, Ministry of Health of Russia
Russian Federation
64, Vorovsky St., Chelyabinsk 454092


I. A. Strokov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
8, Trubetskaya St., Build. 2, Moscow 119991


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
Research and Production Unit, Neurology Clinic, Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers; Ural State Medical University, Ministry of Health of Russia
Russian Federation
30, Popov St., Yekaterinburg 620014
3, 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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Parfenov V.A., Yakhno N.N., Davydov O.S., Kukushkin M.L., Churyukanov M.V., Golovacheva V.A., Evzikov G.Yu., Isaikin A.I., Ivanova M.A., Karateev A.E., Amelin A.V., Achkasov E.E., Akhmadeeva L.R., Bakhtadze M.A., Barantsevich E.R., Barulin A.E., Belova A.N., Belskaya G.N., Bychenko V.G., Doronina O.B., Dreval O.N., Zagorulko O.I., Isagulyan E.D., Iskra D.A., Kalinsky P.P., Karakulova Yu.V., Kurushina O.V., Medvedeva L.A., Merkulova D.M., Rachin A.P., Sergienko D.A., Strokov I.A., Khabirov F.A., Shirokov V.A., Yakupov E.Z. Discogenic lumbosacral radiculopathy. Recommendations of the Russian Association for the Study of Pain (RSSP). Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):15-24. (In Russ.) https://doi.org/10.14412/2074-2711-2020-4-15-24

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