Musculoskeletal back pain, issues of optimizing diagnosis and treatment

Nonspecific (musculoskeletal) neck and back pain (NNBP) is one of the most common reasons for seeking medical advice. The diagnosis of NNBP is based on clinical examination, the absence of signs of dangerous disease ('red flags'), radiculopathy and spinal stenosis. If there are no signs of a dangerous disease, early (within the first 4 weeks) instrumental examination, including magnetic resonance imaging, is not recommended. Fibromyalgia is common among patients with chronic NNBP, but it is rarely diagnosed due to poor awareness among doctors about its manifestations and diagnostic criteria. In NNBP, it is recommended to inform the patient about the favourable prognosis of the disease and risk factors, the need to avoid excessive static and physical exertion, incorrect positions and postures, and the advisability of maintaining physical, social and professional activity. Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are most commonly used to relieve NNBP. Extensive clinical experience has been accumulated regarding the efficacy and safety of aceclofenac (Airtal) as an NSAID and tolperisone (Mydocalm) as a muscle relaxant in the treatment of NNBP. The combination of aceclofenac (Airtal) and tolperisone (Mydocalm) is more effective than monotherapy, as it reduces the duration of NSAID use and lowers the risk of complications from long-term use. For subacute and chronic NNBP, a multimodal approach is most effective, which should include physical exercise (therapeutic physical training – TPT), manual therapy, and, for some patients, psychological therapy methods as non-drug methods. In cases where chronic back pain is caused by fibromyalgia, antiepileptic drugs may be effective as part of complex therapy, among which gabapentin (Tebantin) has been shown to be effective and safe. To prevent NNBP, therapeutic exercise, an educational programme on avoiding excessive static and physical stress, and incorrect positions and postures are recommended.

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