Back pain: the most common errors in diagnosis and therapy
E.S. Filatova1, A.E. Karateev1, E.G. Filatova2
1 Nasonova Research Institute of Rheumatology, Moscow
2 Sechenov University, Moscow
The article discusses some medical errors in the form of unreasonably frequent prescription of neuroimaging for patients with nonspecific back pain, poor knowledge of the clinical signs of inflammatory pain, and characteristics of pain in coxarthritis, which leads to the prescription of incorrect and often expensive and unsafe treatment. When planning approaches to the treatment of acute and sub-acute back pain, attention should be focused on the need to avoid bed rest and maintain reasonable activity, take into account adverse effects when choosing an anesthetic in accordance with the presence of comorbid diseases in the patient, use one drug if necessary in the form of sequential therapy. The results of clinical studies of tenoxicam are described in detail, its pharmacological properties, benefits and therapeutic possibilities are shown.
Key words: back pain, errors, coxarthritis, radiculopathy, tenoxicam, Texared.
For citation: Filatova E.S., Karateev A.E., Filatova E.G. Back pain: the most common errors in diagnosis and therapy // RMJ. Medical Review. 2018. № 11. P. 3–8.
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12. Каратеев А.Е., Яхно Н.Н., Лазебник Л.Б. и др. Применение нестероидных противовоспалительных препаратов. Клинические рекомендации. М.: ИМАПресс, 2009. 167 с. [Karateyev A. Ye., Yakhno N.N., Lazebnik L.B. i dr. Primeneniye nesteroidnykh protivovospalitel’nykh preparatov. Klinicheskiye rekomendatsii. M.: IMAPress, 2009. 167 s. (in Russian)].
13. Brune K., Patrignani P. New insights into the use of currently available non-steroidal anti-inflammatory drugs // J Pain Res. 2015 Feb 20. Vol. 8. Р. 105–118. DOI: 10.2147/JPR.S75160. eCollection 2015.
14. Conaghan P.G. A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity // Rheumatol Int. 2012 Jun. Vol. 32 (6). Р. 1491–1502. DOI: 10.1007/s00296–011–2263–6.
15. Hunter T.S., Robison C., Gerbino P.P. Emerging evidence in NSAID pharmacology: important considerations for product selection // Am J Manag Care. 2015 Apr. Vol. 21 (7 Suppl.). Р. 139–147.
16. Xu S., Rouzer C.A., Marnett L.J. Oxicams, a class of nonsteroidal anti-inflammatory drugs and beyond // IUBMB Life. 2014 Dec. Vol. 66 (12). Р. 803–811. DOI: 10.1002/iub.1334.
17. Lora M., Morisset S., Ménard H.A. et al. Expression of recombinant human cyclooxygenase isoenzymes in transfected COS-7 cells in vitro and inhibition by tenoxicam, indomethacin and aspirin // Prostaglandins Leukot Essent Fatty Acids. 1997 May. Vol. 56 (5). Р. 361–367.
18. Nilsen O.G. Clinical pharmacokinetics of tenoxicam // Clin Pharmacokinet. 1994. Vol. 26 (1). Р. 16–43.
19. Simpson J., Golding D.N., Freeman A.M. et al. A large multicentre, parallel group, double-blind study comparing tenoxicam and piroxicam in the treatment of osteoarthritis and rheumatoid arthritis // Br J Clin Pract. 1989. Vol. 43 (9). Р. 328–333.
20. Moser U., Waldburger H., Schwarz H.A., Gobelet C.A. A double-blind randomised multicentre study with tenoxicam, piroxicam and diclofenac sodium retard in the treatment of ambulant patients with osteoarthritis and extra-articular rheumatism // Scand J Rheumatol Suppl. 1989. Vol. 80. Р. 71–80.
21. Ejstrup L., Knudsen J.V., Petersen L. A randomised double-blind multicentre trial comparing tenoxicam and ketoprofen in osteoarthritis // Scand J Rheumatol Suppl. 1989. Vol. 80. Р. 48–53.
22. Langdon C.G., Moran D.G., Jamieson V. et al. A multicentre study of tenoxicam for the treatment of osteo-arthritis and rheumatoid arthritis in general practice // J Int Med Res. 1990. Vol. 18 (6). Р. 489–496.
2. Breen A.C., Carr E., Langworthy J.E. et al. Back pain outcomes in primary care following a practice improvement intervention: a prospective cohort study // BMC Musculoskelet Disord. 2011. Vol. 12 (1). Р. 28.
3. Groe M., Sadosky A., Stacey B. et al. The burden of chronic low back pain: clinical comorbidities, treatment patterns and heals care cost in usual care settings // Spine. 2012. Vol. 37 (11). E668-E677.
4. Sadosky A., Taylor-Stokes G., Lobasco S. et al. Relationship between self-reported low back pain severity and other patient-reported outcomes: result of observational study // J Spinal. Disord. Tech. 2013. Vol. 26 (1). Р. 8–14.
5. Данилов А.Б. Боль в спине. В кн.: В помощь врачу общей практике. Неврология / под ред. И.Л. Голубева, А.М. Вейна. М.: МЕДпресс-информ, 2018. С. 110–122 [Danilov A.B. Bol’ v spine. V kn.: V pomoshch’ vrachu obshchey praktike. Nevrologiya / pod red. I.L. Golubeva, A.M. Veyna. M.: MEDpress-inform, 2018. S. 110–122 (in Russian)].
6. Филатова Е.С., Эрдес Ш.Ф., Филатова Е.Г. Дифференциальная диагностика воспалительной и механической боли в спине, возможности терапии // Журнал неврологии и психиатрии им. С.С. Корсакова. 2016. T. 116 (6). С. 104–108 [Filatova Ye.S., Erdes Sh.F., Filatova Ye.G. Differentsial’naya diagnostika vospalitel’noy i mekhanicheskoy boli v spine, vozmozhnosti terapii // Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2016. T. 116 (6). S. 104–108 (in Russian)].
7. Rudwaleit M., van der Heijde D., Landewe R. et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection // Annals of the Rheumatic Diseases. 2009. Vol. 68 (6). Р. 777–783. DOI: 10.1136/ard.2009.108233.
8. Jensen M.C., Brant-Zawadzki M.N., Obuchowski N. et al. Magnetic resonance imaging of the lumbar spine in people without back pain // N. Engl. J. Med. 1994. Vol. 331 (2). P. 69–73.
9. Powell M.C., Wilson M., Szypryt P. et al. Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women // Lancet. 1986. Vol. 2 (8520). P. 1366–1367.
10. Haldeman S. North American Spine Society: failure of the pathology model to predict back pain // Spine (Phila Pa 1976). 1990. Vol. 15 (7). P. 718–724.
11. Неспецифическая боль в нижней части спины (дифференциальная диагностика и комплексное лечение). Департамент здравоохранения г. Москвы. Методические рекомендации № 11, М., 2014. 32 с. [Nespetsificheskaya bol’ v nizhney chasti spiny (differentsial’naya diagnostika i kompleksnoye lecheniye). Departament zdravookhraneniya g. Moskvy. Metodicheskiye rekomendatsii № 11, M., 2014. 32 s. (in Russian)].
12. Каратеев А.Е., Яхно Н.Н., Лазебник Л.Б. и др. Применение нестероидных противовоспалительных препаратов. Клинические рекомендации. М.: ИМАПресс, 2009. 167 с. [Karateyev A. Ye., Yakhno N.N., Lazebnik L.B. i dr. Primeneniye nesteroidnykh protivovospalitel’nykh preparatov. Klinicheskiye rekomendatsii. M.: IMAPress, 2009. 167 s. (in Russian)].
13. Brune K., Patrignani P. New insights into the use of currently available non-steroidal anti-inflammatory drugs // J Pain Res. 2015 Feb 20. Vol. 8. Р. 105–118. DOI: 10.2147/JPR.S75160. eCollection 2015.
14. Conaghan P.G. A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity // Rheumatol Int. 2012 Jun. Vol. 32 (6). Р. 1491–1502. DOI: 10.1007/s00296–011–2263–6.
15. Hunter T.S., Robison C., Gerbino P.P. Emerging evidence in NSAID pharmacology: important considerations for product selection // Am J Manag Care. 2015 Apr. Vol. 21 (7 Suppl.). Р. 139–147.
16. Xu S., Rouzer C.A., Marnett L.J. Oxicams, a class of nonsteroidal anti-inflammatory drugs and beyond // IUBMB Life. 2014 Dec. Vol. 66 (12). Р. 803–811. DOI: 10.1002/iub.1334.
17. Lora M., Morisset S., Ménard H.A. et al. Expression of recombinant human cyclooxygenase isoenzymes in transfected COS-7 cells in vitro and inhibition by tenoxicam, indomethacin and aspirin // Prostaglandins Leukot Essent Fatty Acids. 1997 May. Vol. 56 (5). Р. 361–367.
18. Nilsen O.G. Clinical pharmacokinetics of tenoxicam // Clin Pharmacokinet. 1994. Vol. 26 (1). Р. 16–43.
19. Simpson J., Golding D.N., Freeman A.M. et al. A large multicentre, parallel group, double-blind study comparing tenoxicam and piroxicam in the treatment of osteoarthritis and rheumatoid arthritis // Br J Clin Pract. 1989. Vol. 43 (9). Р. 328–333.
20. Moser U., Waldburger H., Schwarz H.A., Gobelet C.A. A double-blind randomised multicentre study with tenoxicam, piroxicam and diclofenac sodium retard in the treatment of ambulant patients with osteoarthritis and extra-articular rheumatism // Scand J Rheumatol Suppl. 1989. Vol. 80. Р. 71–80.
21. Ejstrup L., Knudsen J.V., Petersen L. A randomised double-blind multicentre trial comparing tenoxicam and ketoprofen in osteoarthritis // Scand J Rheumatol Suppl. 1989. Vol. 80. Р. 48–53.
22. Langdon C.G., Moran D.G., Jamieson V. et al. A multicentre study of tenoxicam for the treatment of osteo-arthritis and rheumatoid arthritis in general practice // J Int Med Res. 1990. Vol. 18 (6). Р. 489–496.
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