Back Pain Treatment: A Review of the 2018 Recommendations

Abstract

In 2018, published works that focus on European and American recommendations for the treatment of chronic back pain, where using opioid analgesics, it is recommended to take into account their complexity in multimorbid pathology in patients, since there is no effectiveness of pain reduction due to polypharmacotherapy. The peculiarity of the treatment is that the prevalence of musculoskeletal pain more often reaches its peak in elderly patients and is about 60%, which allows to establish an important direction in therapy - taking into account multimorbid pathology. It is necessary to take into account the accompanying chronic pathology because in patients with back pain hypertension occurs in 58.7%, chronic kidney disease occurs in 29.1% of patients, diabetes mellitus occurs in 23.1% of patients, depressive disorders occur in 15 , 3% of patients. Today it is proved that the common use of NSAIDs is critical for adverse events on the part of their use in patients with multimorbid pathology. In a number of clinical studies, the significant effect of tolperisone has been proven to relieve muscular spasm in acute and chronic back pain compared to tizanidine, where tolperisone is more often used in multimorbid pathology as a relaxant of skeletal muscles. The combination therapy strategy potentially represents a paradigm shift in rehabilitation therapy and can be very important for early intervention in spasticity management processes. In order to expand the scope of potential therapeutic use, the basic requirement for safe treatment is the quantitative basis of evidence of safety and efficacy, which, for example, is now presented in full on tolperisone hydrochloride. The new therapeutic options include a progressive addition of convergent therapy, where it is assumed that the potential for therapeutic purposes will be strengthened in view of the multimorbid pathology in the patient with back pain.