Clinical principles for the diagnosis and treatment of musculoskeletal (non-specific) lower back pain
https://doi.org/10.14412/2074-2711-2021-3-107-112
Abstract
Low back pain (LBP) is one of the most common reasons for a neurologist visit. In 90–95% of cases, LBP is nonspecific (musculoskeletal). The diagnosis of nonspecific LBP based on symptoms, somatic and neurological examination data, the absence of «red flags» (symptoms and signs characteristic of specific causes of back pain, discogenic radiculopathy, or lumbar stenosis). We review the modern principles of acute, subacute, and chronic nonspecific LBP treatment. We also discuss interventional and non-interventional treatment approaches, emphasizing the importance of combination therapy and an interdisciplinary approach.
About the Authors
V. A. GolovachevaRussian Federation
Veronika Aleksandrovna Golovacheva
Department of Nervous System Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine
11, Rossolimo St., Build. 1, Moscow 119021
A. A. Golovacheva
Russian Federation
Department of Nervous System Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine
11, Rossolimo St., Build. 1, Moscow 119021
T. G. Fateyeva
Russian Federation
Department of Nervous System Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine
11, Rossolimo St., Build. 1, Moscow 119021
References
1. Koes BW, van Tulder M, Lin CW, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010 Dec;19(12):2075-94. doi: 10.1007/s00586-010-1502-y. Epub 2010 Jul 3.
2. Podchufarova YeV, Yakhno NN. Bol' v spine [Backache]. Moscow: GEOTAR-Media; 2010. 368 p. (In Russ.).
3. Jordan KP, Kadam UT, Hayward R, et al. Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskelet Disord. 2010 Jul 2;11:144. doi: 10.1186/1471-2474-11-144
4. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2163-96. doi: 10.1016/S0140-6736(12)61729-2. Erratum in: Lancet. 2013 Feb 23;381(9867):628.
5. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Aug 22;386(9995):743-800. doi: 10.1016/S0140-6736(15)60692-4. Epub 2015 Jun 7.
6. Davydov OS. The prevalence of pain syndromes and their impact on quality of life in the world and Russia according to the data of the Global Burden of Disease Study in the period 1990 to 2013. Rossiyskiy Zhurnal Boli. 2015;40(3-4):11-8. Available from: https://painrussia.ru/russian-Journal-ofPain/4715.pdf (In Russ.).
7. Oliveira CB, Maher CG, Pinto RZ, et al. 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):2791-803. doi: 10.1007/s00586-018-5673-2. Epub 2018 Jul 3.
8. Urits I, Burshtein A, Sharma M, et al. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep. 2019 Mar 11;23(3):23. doi: 10.1007/s11916-019-0757-1
9. 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. doi: 10.14412/2074-2711-2018-2-4-11 (In Russ.).
10. Parfenov VA, Yakhno NN, Davydov OS, et al. Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(Suppl. 2):7-16. doi: 10.14412/2074-2711-2019-2S-7-16 (In Russ.).
11. World Health Organization. International statistical classification of disease and relation health problems. 10th ed. Geneva, Switz: World Health Organization; 1992. Available from: https://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf
12. National Institute for Health and Care Excellence (UK). Low Back Pain and Sciatica in Over 16s: Assessment and Management. London; 2016 Nov. Clinical Guidelines. Available from: www.nice.org.uk/guidance/ng5
13. Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-30. doi: 10.7326/M16-2367. Epub 2017 Feb 14.
14. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018 Jan;27(1):60-75. doi: 10.1007/s00586-017-5099-2. Epub 2017 Apr 20.
15. Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ. 2008 Jul 7;337(7662):a171. doi: 10.1136/bmj.a171
16. Da C Menezes Costa L, Maher CG, Hancock MJ, et al. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012 Aug 7;184(11):E613-24. doi: 10.1503/cmaj.111271. Epub 2012 May 14.
17. Wilkes MS. Chronic back pain: does bed rest help? West J Med. 2000;172(2):121. doi: 10.1136/ewjm.172.2.121
18. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017 Feb 18;389(10070):736-47. doi: 10.1016/S0140-6736(16)30970-9. Epub 2016 Oct 11.
19. Parfenov VA. Management of patients with chronic nonspecific lumbar pain. Meditsinskiy sovet = Medical Council. 2019;(1):40-5. doi: 10.21518/2079-701X-2019-1-40-45 (In Russ.).
20. Richmond H, Hall AM, Copsey B, et al. The Effectiveness of Cognitive Behavioural Treatment for Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis. PLoS One. 2015 Aug 5;10(8):e0134192. doi: 10.1371/journal.pone.0134192
21. Anheyer D, Haller H, Barth J, et al. Mindfulness-Based Stress Reduction for Treating Low Back Pain: A Systematic Review and Metaanalysis. Ann Intern Med. 2017 Jun 6;166(11):799- 807. doi: 10.7326/M16-1997. Epub 2017 Apr 25.
22. Roelofs PD, Deyo RA, Koes BW, et al. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD000396. doi: 10.1002/14651858.CD000396.pub3
23. Kuritzky L, Samraj GP. Nonsteroidal anti-inflammatory drugs in the treatment of low back pain. J Pain Res. 2012;5:579-90. doi: 10.2147/JPR.S6775. Epub 2012 Nov 28.
24. Chou R, Deyo R, Friedly J, et al. Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017 Apr 4;166(7):480-92. doi: 10.7326/M16-2458. Epub 2017 Feb 14.
25. Nasonov EL, Yakhno NN, Karateev AE, et al. General principles of treatment for musculoskeletal pain: Interdisciplinary consensus. Nauchnoprakticheskaya revmatologiya = Rheumatology Science and Practice. 2016;54(3):247-65. doi: 10.14412/1995-4484-2016-247-265 (In Russ.).
26. Karateev AE, Nasonov EL, Ivashkin VT, et al. Rational use of nonsteroidal anti-inflammatory drugs. Clinical guidelines. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2018;56(1):1-29. doi: 10.14412/1995-4484-2018-1-29 (In Russ.).
27. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomized placebo-controlled trials. BMJ. 2015 Mar 31;350:h1225. doi: 10.1136/bmj.h1225
28. Williams CM, Maher CG, Latimer J, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014 Nov 1;384(9954):1586-96. doi: 10.1016/S0140-6736(14)60805-9. Epub 2014 Jul 23.
29. 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. doi: 10.17116/jnevro201711711169-78 (In Russ.).
30. Pareek A, Chandurkar N, Chandanwale AS, et al. Aceclofenac-tizanidine in the treatment of acute low back pain: a double-blind, doubledummy, randomized, multicentric, comparative study against aceclofenac alone. Eur Spine J. 2009 Dec;18(12):1836-42. doi: 10.1007/s00586-009-1019-4. Epub 2009 May 7.
31. Pratzel HG, Alken RG, Ramm S. Efficacy and tolerance of repeated oral doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebo-controlled doubleblind trial. Pain. 1996 Oct;67(2-3):417-25. doi: 10.1016/0304-3959(96)03187-9
32. Van Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003;2003(2):CD004252. doi: 10.1002/14651858.CD004252
33. Abdel Shaheed C, Maher CG, Williams KA, McLachlan AJ. Efficacy and tolerability of muscle relaxants for low back pain: Systematic review and meta-analysis. Eur J Pain. 2017 Feb;21(2):228-37. doi: 10.1002/ejp.907. Epub 2016 Jun 22.
34. Mibielli MA, Geller M, Cohen JC, et al. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: the DOLOR study. Curr Med Res Opin. 2009 Nov;25(11):2589-99. doi: 10.3111/13696990903246911
35. Danilov AB. Treatment of acute back pain: B vitamins or NSAIDs? Russkiy meditsinskiy zhurnal. 2010;(0):35-40. Available from: https://www.rmj.ru/articles/bolevoy_sindrom/Lechenie_ostroy_boli_v_spine__vitaminy_gruppy_V_ili_NPVP/ (In Russ.).
36. Calderon-Ospina C-A, Nava-Mesa MO, Carlos Emilio Arbelaez Ariza CE. Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain Management: Systematic Review and Meta-analysis. Pain Med. 2020 Apr 1;21(4):766-81. doi: 10.1093/pm/pnz216
37. Brüggemann G, Koehler CO, Koch EM. Ergebnisse einer Doppelblindprüfung Diclofenac + Vitamin B1, B6, B12 versus Diclofenac bei Patienten mit akuten Beschwerden im Lendenwirbelsäulenbereich. Eine Multicenterstudie [Results of a doubleblind study of diclofenac + vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study]. Klin Wochenschr. 1990 Jan 19;68(2):116-20. doi: 10.1007/BF01646858 (In Germ.).
38. Mauro GL, Martorana U, Cataldo P, et al. Vitamin B12 in low back pain: a randomised, double-blind, placebo-controlled study. Eur Rev Med Pharmacol Sci. 2000 May-Jun;4(3):53-8.
39. Strokov IA, Drokonova OO, Akhmedzhanova LT. Treatment of back pain: a modern view on the use of NSAIDs and vitamins of group B. RMJ «Meditsinskoye obozreniye». 2015;(2):104. Available from: https://www.rmj.ru/articles/obshchiestati/Lechenie_boley_v_spine_sovremennyy_vzglyad_na_primenenie_NPVP_i_vitaminov_gruppy_V/ (In Russ.).
40. Kukushkin M.L. Vitamins of group B (B1, B6, B12) in complex therapy of pain syndromes. Rossiyskiy zhurnal boli = Russian Journal of Pain. 2019;17(3):39-45. doi: 10.25731/RASP.2019.03.31 (In Russ.).
41. Zhuravleva MV, Shikh EV, Makhova AA. A relationship between analgesic and neurotropic effects by the example of milgamma. Terapevticheskii arkhiv. 2012;84(12):131-4 (In Russ.).
42. Simeonov S, Pavlova M, Mitkov M, et al. Therapeutic efficacy of «Milgamma» in patients with painful diabetic neuropathy. Folia Med (Plovdiv). 1997;39(4):5-10. Available from: https://www.pubfacts.com/detail/9575643/Therapeutic-efficacy-of-Milgamma-in-patientswith-painful-diabetic-neuropathy
43. Amir J, Ginat S, Cohen YH, et al. Lidocaine as a diluent for administration of benzathine penicillin G. Pediatr Infect Dis J. 1998;17(10):890-3. doi: 10.1097/00006454-199810000-00008
44. Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013 Apr;16(2 Suppl):S49-283.
Review
For citations:
Golovacheva V.A., Golovacheva A.A., Fateyeva T.G. Clinical principles for the diagnosis and treatment of musculoskeletal (non-specific) lower back pain. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(3):107-112. (In Russ.) https://doi.org/10.14412/2074-2711-2021-3-107-112