NON-SPECIFIC BACK PAIN: DIAGNOSIS AND THERAPY FROM THE POSITION OF EVIDENTIAL MEDICINE (REVIEW OF LITERATURE)

Sergey Yu. Tereshchenko

doi:10.12731/2658-6649-2022-14-5-392-401

Sergey Yu. Tereshchenko Federal State Budgetary Scientific Institution «Scientific Research Institute of medical problems of the North» https://orcid.org/0000-0003-4268-6568

DOI: https://doi.org/10.12731/2658-6649-2022-14-5-392-401

Keywords: review, back pain, diagnosis, therapy, evidence-based medicine

Abstract

The purpose of this publication is an attempt to systematize modern data based on the principles of evidence-based medicine (controlled randomized trials, systematic reviews, meta-analyses) in the field of diagnosis and treatment of non-specific low back pain. It is shown that non-specific lumbar pain is the predominant type of lumbar pain syndrome. The basis for the diagnosis of nonspecific low back pain should be a detailed history taking and a thorough physical and neurological examination. The value of imaging diagnostic methods is limited to patients with red flags. Both in the case of acute and chronic non-specific low back pain, the basis of therapy with well-proven effectiveness is patient education, manipulative techniques and special physical therapy. In the case of chronic non-specific low back pain, behavioral therapy is highly effective. Non-steroidal anti-inflammatory drugs have proven efficacy in relation to pain and functioning of the patient. In the case of chronic non-specific low back pain, muscle relaxants and antidepressants may be additionally prescribed.

Downloads

Download data is not yet available.

Author Biography

Sergey Yu. Tereshchenko, Federal State Budgetary Scientific Institution «Scientific Research Institute of medical problems of the North»

Doctor оf Medical Sciences, Professor, Head. Department of Somatic and Mental Health of Children

References

Список литературы / References

Brinjikji W., Diehn F.E., Jarvik J.G., Carr C.M. et al. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and MetaAnalysis. AJNR Am J Neuroradiol, 2015, vol. 36, no. 12, pp. 2394-2399. http://doi.org/10.3174/ajnr.A4498

Cashin A.G., Folly T., Bagg M.K., Wewege M.A. et al. Efficacy, acceptability, and safety of muscle relaxants for adults with nonspecific low back pain: systematic review and metaanalysis. Bmj, 2021, vol. 374, p. n1446. http://doi.org/10.1136/bmj.n1446.

Chen Y., Campbell P., Strauss V.Y., Foster N.E. et al. Trajectories and predictors of the longterm course of low back pain: cohort study with 5year followup. Pain, 2018, vol. 159, no. 2, pp. 252-260. http://doi.org/10.1097/j.pain.0000000000001097

Chiarotto A., Koes B.W. Nonspecific Low Back Pain. N Engl J Med, 2022, vol. 386, no. 18, pp. 1732-1740. http://doi.org/10.1056/NEJMcp2032396

Deyo R.A., Loeser J.D., Bigos S.J. Herniated lumbar intervertebral disk. Ann Intern Med, 1990, vol. 112, no. 8, pp. 598-603. doi: 10.7326/000348191128598.

Enthoven W.T., Roelofs P.D., Deyo R.A., Van Tulder M.W. et al. Nonsteroidal antiinflammatory drugs for chronic low back pain. Cochrane Database Syst Rev, 2016, vol. 2, no. 2, p. Cd012087. http://doi.org/10.1002/14651858.cd012087

Ferreira G.E., Mclachlan A.J., Lin C.W.C., Zadro J.R. et al. Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and metaanalysis. BMJ, 2021, vol. 372, p. m4825. http://doi.org/10.1136/bmj.m4825

Foster N.E., Anema J.R., Cherkin D., Chou R. et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet, 2018, vol. 391, no. 10137, pp. 2368-2383. http://doi.org/10.1016/s01406736(18)304896

French S.D., Cameron M., Walker B.F., Reggars J.W. et al. Superficial heat or cold for low back pain. Cochrane Database Syst Rev, 2006, vol. 2006, no. 1, p. Cd004750. http://doi.org/10.1002/14651858.CD004750.pub2

Furlan A.D., Giraldo M., Baskwill A., Irvin E. et al. Massage for lowback pain. Cochrane Database Syst Rev, 2015, vol. 2015, no. 9, p. Cd001929. http://doi.org/10.1002/14651858.CD001929.pub3

Furlan A.D., Malmivaara A., Chou R., Maher C.G. et al. 2015 Updated Method Guideline for Systematic Reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976), 2015, vol. 40, no. 21, pp. 1660-1673. http://doi.org/10.1097/brs.0000000000001061

Hancock M.J., Maher C.G., Latimer J., Spindler M.F. et al. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J, 2007, vol. 16, no. 10, pp. 1539-1550. doi: 10.1007/s0058600703911.

Hartvigsen J., Hancock M.J., Kongsted A., Louw Q. et al. What low back pain is and why we need to pay attention. Lancet, 2018, vol. 391, no. 10137, pp. 2356-2367. http://doi.org/10.1016/s01406736(18)30480x

Hayden J.A., Ellis J., Ogilvie R., Stewart S.A. et al. Some types of exercise are more effective than others in people with chronic low back pain: a network metaanalysis. J Physiother, 2021, vol. 67, no. 4, pp. 252-262. http://doi.org/10.1016/j.jphys.2021.09.004

Hayden J.A., Van Tulder M.W., Malmivaara A., Koes B.W. Exercise therapy for treatment of nonspecific low back pain. Cochrane Database Syst Rev, 2005, no. 3, p. Cd000335. http://doi.org/10.1002/14651858.CD000335.pub2

Henschke N., Ostelo R.W., Van Tulder M.W., Vlaeyen J.W. et al. Behavioural treatment for chronic lowback pain. Cochrane Database Syst Rev, 2010, vol. 2010, no. 7, p. Cd002014. http://doi.org/10.1002/14651858.CD002014.pub3

Hoy D., Bain C., Williams G., March L. et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum, 2012, vol. 64, no. 6, pp. 2028-2037. http://doi.org/10.1002/art.34347

Karran E.L., Mcauley J.H., Traeger A.C., Hillier S.L. et al. Can screening instruments accurately determine poor outcome risk in adults with recent onset low back pain? A systematic review and metaanalysis. BMC Med, 2017, vol. 15, no. 1, p. 13. http://doi.org/10.1186/s1291601607744

Koes B.W., Van Tulder M.W., Thomas S. Diagnosis and treatment of low back pain. BMJ (Clinical research ed.), 2006, vol. 332, no. 7555, pp. 1430-1434. http://doi.org/10.1136/bmj.332.7555.1430

Kongsted A., Kent P., Axen I., Downie A.S. et al. What have we learned from ten years of trajectory research in low back pain? BMC Musculoskeletal Disorders, 2016, vol. 17, no. 1, p. 220. http://doi.org/10.1186/s1289101610712

Lee J.H., Choi T.Y., Lee M.S., Lee H. et al. Acupuncture for acute low back pain: a systematic review. Clin J Pain, 2013, vol. 29, no. 2, pp. 172-185. http://doi.org/10.1097/AJP.0b013e31824909f9

Maas E.T., Juch J.N., Ostelo R.W., Groeneweg J.G. et al. Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints. Eur J Pain, 2017, vol. 21, no. 3, pp. 403-414. http://doi.org/10.1002/ejp.963

Raastad J., Reiman M., Coeytaux R., Ledbetter L. et al. The association between lumbar spine radiographic features and low back pain: a systematic review and metaanalysis. Semin Arthritis Rheum, 2015, vol. 44, no. 5, pp. 571-585. http://doi.org/10.1016/j.semarthrit.2014.10.006

Rubinstein S.M., De Zoete A., Van Middelkoop M., Assendelft W.J.J. et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and metaanalysis of randomised controlled trials. Bmj, 2019, vol. 364, p. l689. http://doi.org/10.1136/bmj.l689

Saragiotto B.T., Machado G.C., Ferreira M.L., Pinheiro M.B. et al. Paracetamol for low back pain. Cochrane Database Syst Rev, 2016, vol. 2016, no. 6, p. Cd012230. http://doi.org/10.1002/14651858.cd012230

Steffens D., Maher C.G., Pereira L.S., Stevens M.L. et al. Prevention of Low Back Pain: A Systematic Review and Metaanalysis. JAMA Intern Med, 2016, vol. 176, no. 2, pp. 199-208. http://doi.org/10.1001/jamainternmed.2015.7431

Taylor J.B., Goode A.P., George S.Z., Cook C.E. Incidence and risk factors for firsttime incident low back pain: a systematic review and metaanalysis. Spine J, 2014, vol. 14, no. 10, pp. 2299-2319. http://doi.org/10.1016/j.spinee.2014.01.026

Traeger A.C., Henschke N., Hübscher M., Williams C.M. et al. Estimating the Risk of Chronic Pain: Development and Validation of a Prognostic Model (PICKUP) for Patients with Acute Low Back Pain. PLoS Med, 2016, vol. 13, no. 5, p. e1002019. http://doi.org/10.1371/journal.pmed.1002019

Traeger A.C., Hübscher M., Henschke N., Moseley G.L. et al. Effect of Primary CareBased Education on Reassurance in Patients With Acute Low Back Pain: Systematic Review and Metaanalysis. JAMA Intern Med, 2015, vol. 175, no. 5, pp. 733-743. http://doi.org/10.1001/jamainternmed.2015.0217

Van Der Gaag W.H., Roelofs P.D., Enthoven W.T., Van Tulder M.W. et al. Nonsteroidal antiinflammatory drugs for acute low back pain. Cochrane Database Syst Rev, 2020, vol. 4, no. 4, p. Cd013581. http://doi.org/10.1002/14651858.cd013581

FOR AUTHORS

EDITORIAL POLICIES