Management of patients with subacute back pain: how to effectively prevent chronicity

Abstract

A clinical observation of a patient with subacute nonspecific lower back pain and comorbid panic disorder is presented; it illustrates a modern approach to the management of this type of patients. Subacute back pain is the transition from acute to chronic pain. Clinically, the pain becomes constant, exhausting the patient and reducing his quality of life, and pathophysiologically, the pain transforms from nociceptive to dysfunctional. Chronicity of musculoskeletal pain does not occur in conditions of mental and social well-being, the patient necessarily has the so-called “yellow flags” – factors that contribute to central sensitization and chronic pain. In the presented clinical case, the most common “yellow flags” were identified – anxiety, misunderstanding about the causes of back pain, pain catastrophizing, restrictive “pain” behavior. These factors are often found among patients with subacute back pain. It is important to identify “yellow flags” timely and treat patient taking into account their correction. For the treatment of this category of patients, the prescription of pain therapy alone is not enough, an interdisciplinary approach is needed, which will include rational pharmacotherapy, psychological methods and kinesiotherapy. The patient underwent interdisciplinary treatment, including non-drug and drug therapies and in accordance with Russian and foreign clinical guidelines for the treatment of subacute nonspecific lower back pain and panic disorder. Non-drug treatment consisted of educational talks, recommendations for daily activities, cognitive behavioral therapy, and kinesiotherapy. These methods were aimed at forming the patient's correct ideas about his condition, at reducing the catastrophizing of pain and anxiety, and at increasing the patient's physical and social activity. It is known that many patients with pain syndromes have insufficient adherence to treatment and adherence to medical recommendations. Patient adherence to non-drug treatments was maintained through educational conversations and cognitive-behavioral therapy. Taking into account the previous multiple intake of non-steroidal anti-inflammatory drugs and in order to avoid the risk of side effects, drugs of this group were not included in the present pharmacotherapy plan. The patient was prescribed Alflutop as a pharmacotherapy. After 10 days of treatment, a marked relief of pain was observed, and after 3 weeks of treatment, back pain regressed, and anxiety significantly decreased. The patient has formed correct ideas about his condition, about his lifestyle. Follow-up of the patient for 12 months showed that there were no repeated episodes of back pain and panic attacks. The patient continued to regularly engage in kinesiotherapy and maintain an active lifestyle.