Comorbidity in back pain

Abstract

A significant problem of modern medicine is the presence of several diseases in the same patient, which complicates not only the diagnosis of each of them, but also therapy. It is necessary to distinguish between the terms “comorbidity”, “multimorbidity” and “polymorbidity”. The principles of therapy for comorbid patients differ from those for patients with mononosology. А large number of Russian and foreign studies have shown that patients with chronic pain syndromes, including chronic back pain, often have a number of comorbid conditions. In particular, in patients with osteoarthritis, which is one of the most common causes of back pain, diseases of the cardiovascular system, lungs, gastrointestinal tract, diabetes mellitus, and obesity are more often recorded. The article describes a clinical case of a patient with the simultaneous presence of several diseases: myofascial pain syndrome, peroneal tunnel neuropathy, diabetes type 2, polyosteoarthritis, joint hypermobility syndrome, herniated disc, obesity. At the same time, some of these diseases are comorbid, while the other part is a multimorbid disease, which must be taken into account when making a diagnosis and selecting therapy. In addition, the described case from practice illustrates the priority of the clinical method of examining a patient over paraclinical ones. The choice of pharmacological drugs and non-drug methods of treatment recommended to the patient was dictated by the mixed nature of the pain. A non-steroidal anti-inflammatory drug, SYSADOA, and a muscle relaxant have been recommended to combat non-specific musculoskeletal pain. Neuropathic pain treatment, in accordance with clinical recommendations, the following groups of drugs were included: gabapentinoids, vitamins B, anticholinesterases.