Abstract
Chronic nonspecific low back pain (LBP) is the most common cause of disability and a lower quality of life in modern society. Objective : to discuss the feasibility of identifying the causes of chronic nonspecific LBP and in the case of detection of damage to the facet joint (FJ) or sacroiliac joint (SIJ), use of nonsteroidal anti-inflammatory drugs (NSAIDs), and injection of anesthetics and glucocorticoids into the region of the FJ or SIJ. Patients and methods . A total of 121 female patients aged 22 to 59 years with chronic nonspecific LBP were followed up. A FJ lesion was found in 53 (43.8%) patients. The patients were informed of a favorable disease prognosis, had motor activity recommendations, and were also prescribed NSAIDs and muscle relaxants. Twenty-eight (23%) patients achieved a clinically significant analgesic effect within 2 weeks; the remaining 93 (77%) patients received combination therapy with anesthetics injected into the region of the FJ and SIJ. Results and discussion. The basis for successful personified therapy in these patients is shown to be adequate diagnosis by identifying of the prevailing sources of pain impulses (triggers), and by using minimally invasive diagnostic methods, such as local injection of a local anesthetic solution into the suspected pain trigger. The high efficiency of combination therapy for chronic nonspecific LBP, which included anesthetics injected into the region of the FJ and SIJ, and is largely associated with rapid pain elimination, which is of great psychological importance. The central mechanisms of action of NSAIDs, etoricoxib in particular, are discussed. Conclusion. Thus, elucidation of the causes of chronic nonspecific LBP in a patient makes it possible to recommend personalized therapy aimed at eliminating not only the symptoms, but also the underlying cause of the disease. The use of etoricoxib for FJ lesion, which shows the highest analgesic efficacy in patients with osteoarthritis is pathogenetically justified and should be combined with nondrug treatments.
Highlights
Хроническая неспецифическая боль в нижней части (БНЧС) – самая частая причина нарушения трудоспособности и снижения качества жизни в современном обществе
The patients were informed of a favorable disease prognosis, had motor activity recommendations, and were prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants
Twenty-eight (23%) patients achieved a clinically significant analgesic effect within 2 weeks; the remaining 93 (77%) patients received combination therapy with anesthetics injected into the region of the facet joint (FJ) and sacroiliac joint (SIJ)
Summary
Рожков Д.О.1, Зиновьева О.Е.1, Баринов А.Н.1, Носовский А.М.2 1Кафедра нервных болезней и нейрохирургии Института клинической медицины ФГАОУ ВО «Первый Московский государственный медицинский университет им. Цель исследования – обсуждение целесообразности выявления причин хронической неспецифической БНЧС и в случае обнаружения поражения фасеточного сустава (ФС) или крестцово-подвздошного сочленения (КПС) применения нестероидных противовоспалительных препаратов (НПВП) и введения анестетиков и глюкокортикоидов в область ФС или КПС. Высокая эффективность включения в комплексную терапию хронической неспецифической БНЧС введения анестетиков в область ФС и КПС во многом связана с быстрым устранением боли, что имеет большое психологическое значение. Среди всех причин как острой, так и хронической боли в нижней части спины (БНЧС) скелетно-мышечная боль (СМБ), связанная с поражением суставов (спондилоартрит) и мышечно-связочного аппарата позвоночника, встречается в 90% случаев [3]. Цель исследования – обсуждение целесообразности выявления причин хронической неспецифической БНЧС и в случае обнаружения поражения ФС или КПС применения нестероидных противовоспалительных препаратов (НПВП) и введения анестетиков и глюкокортикоидов в область ФС или КПС [3]. 121 пациентки тов с хронической неспецифической БНЧС [12, 13]
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