Optimization of the management of patients with nonspecific chronic low back pain

Abstract

The management of patients with chronic (>3-month) nonspecific pain in the lumbar region (low back pain (LBP)) is an actual problem of modern medicine. It is noted in many countries that an integrated approach to treating these patients is effective; however, this approach is not yet applied in our country. Objective: to clarify the efficiency of combination treatment using cognitive behavioral therapy (CBT), therapeutic exercises in patients with nonspecific chronic LBP (NCLBP). Patients and methods. Sixty patients (19 men and 41 women; their mean age was 50.3±1.97 years) with NCLP underwent a comprehensive clinical, neurological, and psychological examination and treatment and were followed up for 1 year. Results. It was ascertained that the frequency of erroneous beliefs about back pain was high in patients with NCLBP and these ideas and concomitant anxiety and depressive disorders, sleep disorders, and headache had a negative impact on treatment outcomes. The integrated approach using therapeutic exercises, CBT was noted to be effective in both the immediate (within 1 month) and late (after 1 year) period. During the follow-up, there was a considerable increase in the proportion of patients performing therapeutic exercises (from 28 to 85% after 3 months); adherence to the latter remained in most (71.7%) patients. Conclusion. When patients with NCLP are managed, it is important to use therapeutic exercises, CBT (to clarify patients' ideas, to explain the true causes of this disease and its favorable outcome), and to identify and treat concomitant anxiety and depressive disorders, headache, and sleep disorders.