Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Musculoskeletal pain in the lumbosacral region

https://doi.org/10.14412/2074-2711-2011-144

Full Text:

Abstract

Musculoskeletal pain associated with nonspecific changes in the vertebral structures and paravertebral muscles is the most common type of
back pain. There is an association between back pain and education level, low physical activity, smoking intensity, and the frequency of
bending and weight lifting during work; hereditary predisposition is also important. On examining a patient, it is important to rule out pain
caused by a serious problem: severe somatic diseases, vertebral damages of specific etiology (injuries, neoplasms, infectious and inflammatory
processes), compression damages, and psychogenic diseases. Adjacent joint diseases frequently imitate verterogenic pain. In back pain, there
are most commonly three major clinical syndromes: vertebral, myogenic, and radicular. Neurological and orthopedic examinations are one of
the most informative diagnostic techniques for musculoskeletal pain. Most patients with musculoskeletal pain do not need neuroimaging.
Psychological factors are of great importance in the chronization of pain. Among non-drug treatments, early patient activation, walking, and
swimming play a vital part; a fixing belt may be used in the acute phase. Adequate manual therapy is highly effective. Medical therapy
includes nonsteroidal anti-inflammatory drugs in combination with myorelaxants, as well as therapeutic blocks. Psychotherapeutic procedures,
therapeutic exercises, and antidepressants are used to treat chronic pain.

References

1. <div><p>Kinkade S. Evaluation and Treatment of Acute Low Back Pain. AVF 2007;3:1190-3.</p><p>Low Back Pain Fact Sheet, NINDS. 2001;13:11-2.</p><p>Штульман Д.Р., Левин О.С. Неврология. Справочник практического врача. М.: Медпресс, 2007;81 - 107.</p><p>Алексеев В.В. Неврологические аспекты диагностики и лечения острых вертеброгенных болевых синдромов. Consilium medicum 2008;1:56-63.</p><p>Подчуфарова Е.В., Яхно Н.Н. Боли в спине и конечностях. Болезни нервной системы. Рук-во для врачей. Т.2. М.: Медицина, 2005;306-31.</p><p>Bratton R.L. Assessment and Management of Acute Low Back Pain. AVF 1999;15(1):322-8.</p><p>Koes B.W., van Tulder M., Lin Chung-Wei Christine et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010;19(12):2075-94.</p><p>Patel A.T., Ogle A.A. Diagnosis and Management of Acute Low Back Pain. Am Family Physician 2000;15:776-81.</p><p>Черненко О.А. Лечение болевых скелетно-мышечных поясничных синдромов. РМЖ 2000;8(10):408-10.</p><p>Airaksinen O., Brox J.I. et al. European guidelines for management of chronic low back pain. Eur Spine J 2006;15(2):S119-S300.</p><p>Chou R., Qaseem A., Snow V. et al. Diagnosis and treatment of low-back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147(7):478-91.</p><p>Depalma M.J., Ketchum J.M., Trussell B.S. et al. Does the location of low back pain predict its source. PMR 2011;3(1):33-9.</p><p>Eichenseer P.H., Sybert D.R., Cotton J.R. A Finite Element Analysis of Sacroiliac Joint Ligaments in Response to Different Loading Conditions. Spine 2011;9:78-82.</p><p>Haldeman S., Kohlbeck F.J., McGregor M. Stroke, cerebral artery dissection, and cervical spine manipulation therapy. J Neurol 2002;249(8):1098-104.</p><p>Paalanne N., Niinimaki J., Karppinen J. et al. Assessment of association between low back pain and paraspinal muscle atrophy using Opposed-Phase MR imaging. A population-based study among young adults. Spine (Phila Pa 1976). 2011;1:29-31.</p><p>Deyo R.A., Weinstein J.N., Low Back Pain. N Engl J Med 2001;1:363-70.</p><p>Van Goethem J., Venstermans C., Parizel P. Correct Application of MRI: helps find causes of lower back pain. The main challenge for clinicians is to distinguish serious spinal pathology from nonspecific lumbar discomfort. Diagnostic Imaging 2008;32(7):29-31.</p><p>Vora A.J., Doerr K.D., Wolfer L.R. Functional anatomy and pathophysiology of axial low back pain: disc, posterior elements, sacroiliac joint, and associated pain generators. Phys Med Rehabil Clin N Am 2010;21(4):679-709.</p><p>Hills E.C. Mechanical Low Back Pain. Treatment &amp; Medication Updated 2010;5:11-2.</p><p>Mahato N.K. Facet Dimensions, Orientation and Symmetry at L5-S1 Junction in Lumbo-Sacral Transitional States. Spine (Phila Pa 1976). 2011;27:36-41.</p><p>Cohen S.P., Raja S.N. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology 2007;106(3):591-614.</p><p>De Luigi A.J., Fitzpatrick K.F. Physical examination in radiculopathy. Phys Med Rehabil Clin N Am 2011;22(1):7-40.</p><p>Rho M.E., Tang C.T. The efficacy of lumbar epidural steroid injections: transforaminal, interlaminar, and caudal approaches. Phys Med Rehabil Clin N Am 2011;22(1):139-48.</p><p>Chou R., Huffman L.H. Nonpharmacologic therapies for acute and chronic low-back pain: a review of the evidence for and American Pain Society. American College of Physicians clinical practice guideline. Ann Intern Med 2007;147(7):492-504.</p><p>Подчуфарова Е.В., Разумов Д.В. Роль болевого поведения в формировании инвалидизации у пациентов с хронической болью в спине. РМЖ 2010;3:87-9.</p><p>Forrest J.B., Camu F., Greer I.A. еt al. Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery. Br J Anaesth 2002;88(2):227-33.</p><p>Chou R., Qaseem A., Owens D.K. et al. For the Clinical Guidelines Committee of the American College of Physicians. Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Ann Intern Med 2011;154(3):181-9.</p><p>Veenema K.R., Leahey N., Schneider S. Ketorolac versus meperidine: ED treatment of severe musculoskeletal low back pain. Am J Emerg Med 2000;18(4):404-7.</p><p>Catapano M.S. The analgesic efficacy of ketorolac for acute pain. J Emerg Med 1996;14(1):67-75.</p><p>Franceschi F., Buccelletti F., Marsiliani D. et al. Acetaminophen plus codeine compared to ketorolac in polytrauma patients. Eur Rev Med Pharmacol Sci. 2010;14(7):629-34.</p><p>Галушко Е.А., Зоткин Е.Г., Салихов И.Г. и др. Клиническая эффективность и переносимость различных НПВП при остеоартрозе с выраженным болевым синдромом. Леч врач 2008;4:34-6.</p><p>Pohjolainen T., Jekunen A., Autio L. et al. Treatment of acute low back pain with the COX-2-selective anti-inflammatory drug nimesulide: results of a randomized, double-blind comparative trial versus ibuprofen. Spine (Phila Pa 1976). 2000;25(12):1579-85.</p><p>Roelofs P.D., Deyo R.A., Koes B.W. et al. Nonsteroidal antiinflammatory drugs for low back pain: an updated Cochrane review. Spine (Phila Pa 1976). 2008;33(16):1766-74.</p><p>Шостак Н.А. Возможности оптимизации анальгетической и противовоспалительной терапии у больных с острым болевым синдромом в спине. РМЖ 2006;8(14):40-3.</p><p>Алексеев В.В. Бетамизон (дипроспан) в лечении болевых синдромов. Клин фармакол и тер 2003;5:94-6.</p><p>Холопов А.В., Агаркова Л.А. Эпидуральные блокады в лечении острого корешкового болевого синдрома у женщин. Сиб мед журн 2003;1:87-9.</p><p>Manchikanti L., Cash K.A., McManus C.D. et al. One-year results of a randomized, double-blind, active controlled trial of fluoroscopic caudal epidural injections with or without steroids in managing chronic discogenic low back pain without disc herniation or radiculitis. Pain Physician 2011;14(1):25-36.</p><p>Cherkin D.C., Sherman K.J., Deyo R.A. et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Annals of Internal Medicine. 2003;138(11):898-906.</p><p>Coulter I.D., Hurwitz E.L., Adams A.H. et al. Patients using chiropractors in North America: who are they, and why are they in chiropractic care? Spine 2002;27(3):291-6.</p><p>Ferreira M.L., Ferreira P.H., Latimer J. et al. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial. Pain 2007;131(1-2):31-7.</p><p>Gudavalli M.R., Cambron J.A., McGregor M. et al. A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain. Eur Spine J 2006;15(7):1070-82.</p><p>Walker B.F., French S.D., Grant W. et al. A Cochrane review of combined chiropractic interventions for low-back pain. Spine (Phila Pa 1976). 2011;36(3):230-42.</p></div><br />


For citation:


Isaykin A.I., Isaikin A.I. Musculoskeletal pain in the lumbosacral region. Neurology, Neuropsychiatry, Psychosomatics. 2011;3(2):34-41. (In Russ.) https://doi.org/10.14412/2074-2711-2011-144

Views: 501


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


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