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Lumbosacral pain: Delivery of care to patients in the United Kingdom Podchufarova E.

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Musculoskeletal pain syndromes are one of the most common causes of disability and referral to a medical specialist. Seven million consultations for lumbosacral pain are annually carried out in the United Kingdom.

Examination of patients with back pain. Three levels of health care delivered to patients with back pain in the United Kingdom may be arbitrarily identified. Level 1 is outpatient: a general practitioner jointly with a manipulative therapist, a physiotherapist, a rehabilitation specialist, and mid-level health workers render care to patients with insignificant and mild pain syndrome; Level 2 is also outpatient, which involves the participation of a hospital or multidisciplinary team consultant, for example, in a musculoskeletal pain service or a specialized pain center; Level 3 is to deliver care at neurosurgical or orthopedic hospital, by applying invasive interventions. Acute back pain is a benign condition in the vast majority of cases; there is no need for additional instrumental and laboratory studies; but spinal X-ray study, computed tomography (СT scan), or magnetic resonance imaging (MRI), general blood and urine tests are required when marked neurological and somatic disorders are present.

Management of patients with acute lumbosacral pain is to inform a patient about the benign nature of the disease; to exclude bed rest; to explain the need to maintain normal activity; to train how to correctly lift weights and to maintain normal posture; to refer for manual and exercise therapy in order to return to normal motor activity; to use proven effective medication. In most cases, acute back pain goes away spontaneously for a short period of time; an active treatment approach is considered to be optimal. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are used for analgesia if required. Patients who show no improvement after 4 weeks of treatment need rescreening for markers of potentially dangerous spinal diseases, as well as determination of the signs of psychosocial ill-being and correction of therapy with consideration for identified disorders.

Management of patients with subacute and chronic pain (persisting for >6 weeks, but <1 year) involves the regular reconsideration of whether the diagnosis of nonspecific back pain is correct in order to rule out possible specific causes. MRI is indicated when a patient is decided to be referred for surgical treatment or there is presumptive evidence for spinal tumors, infectious, inflammatory, or traumatic injury, or cauda equina syndrome. It is optimal to start treatment with a program of therapeutic exercises, manual therapy, or acupuncture. Drug therapy encompasses NSAIDs, acetaminophen, and opioids to treat intensive pain syndrome.

About the Author

E.V. Podchufarova
United Kingdom


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For citations:

Podchufarova E. Lumbosacral pain: Delivery of care to patients in the United Kingdom Podchufarova E. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(2):75-80. (In Russ.)

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