Treatment of acute and chronic cervical musculoskeletal pain

Abstract

Pain in the cervical spine is a widespread condition that significantly disrupts the quality of life, often leads to disability and requires significant economic costs. The most common type of neck pain is nonspecific (vertebrogenic cervicalgia). The most frequent (in 36–67% of cases) anatomical source of nonspecific neck pain is considered to be the lesion of the intervertebral facet joints. Tests to determine the anatomical sources of nonspecific pain are unreliable, in addition, their detection does not significantly affect treatment. Degenerative changes of the spine are often detected during neuroimaging, depend on age, but do not correlate with clinical symptoms and severity of symptoms. In the absence of red flags of anxiety and negative results of neurological examination, neuroimaging or laboratory methods of research are not required. An assessment of prognostic factors is important. Factors contributing to chronization include: female sex, old age, high intensity of pain at the onset of the disease, the presence of psychosocial problems. Modern classifications, the basics of diagnosis, treatment and prevention of nonspecific neck pain are given. Modern effective methods of treatment are physical therapy, manual therapy and psychological programs, a multimodal approach to treatment is optimal. There is a very low level of evidence for electrotherapy, traction, laser therapy, acupuncture, dry needle treatment, thermal or cold procedures. The use of drug therapy is recommended, both separately and in combination with other methods of treatment. The most effective painkillers for neck pain are non-opioid analgesics – NSAIDs and paracetamol. The use of cervical orthosis is not recommended. Clinical cases of patients with acute and chronic nonspecific neck pain are described. The effectiveness of an integrated approach to the management of this category of patients, in accordance with modern recommendations, is shown. The treatment included drug and non-drug methods (therapeutic gymnastics, educational conversation). Dexketoprofen was used as pharmacotherapy according to a step-by-step regimen.