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A new look at back pain treatment in light of the latest ESCEO guidelines

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Chronic pain (CP) is still one of the urgent problems of modern medicine. The paper provides a review of the main pharmacotherapeutic approaches from the standpoint of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) guidelines. When preparing this material, the authors have analyzed the publications available in the resources: PubMed, EMBASE, Cochrane, and еLIBRARY. The paper presents the main pathogenetic mechanisms of pain syndrome development in osteoarthritis (OA), including synovial inflammation and associated immune disorders. It considers the types of development of pain syndrome and the main prognostic outcomes according the mechanism of pain, providing a rationale for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or chondroprotectors (CPs). In accordance with the ESCEO guidelines, it is noted that when starting OA therapy, CPs should be considered as the first step (in their long-term prescription and pharmaceutical quality), then NSAIDs should be added (topically), then (if ineffective) orally, by excluding patients with hip OA. It is known that the intramuscular administration of CPs (chondroitin sulfate (CS) in particular) can increase their bioavailability. The use of glucosamine sulfate (GS) is recommended for patients over 60 years of age. According to the recommendations of the 2019 ESCEO experts, CS and GS should be used as a disease-modifying OA drug from the first step and at all subsequent stages.

About the Authors

O. A. Shavlovskaya
Mental Health Research Center
Russian Federation

Olga Aleksandrovna Shavlovskaya

34A, Kashirskoe Shosse, Moscow 115522

I. A. Zolotovskaya
Samara State Medical University, Ministry of Health of Russia
Russian Federation

89, Chapaevskaya St., Samara 443099

Yu. A. Prokofyeva
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia; S.I. Spasokukotsky Moscow City Clinical Hospital, Moscow Healthcare Department
Russian Federation

20, Delegatskaya St., Build. 1, Moscow 127473,

21, Vuchetich St., Moscow 127206


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For citations:

Shavlovskaya O.A., Zolotovskaya I.A., Prokofyeva Yu.A. A new look at back pain treatment in light of the latest ESCEO guidelines. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(6):90-95. (In Russ.)

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)