Russian Medical Inquiry
(RMZh. Meditsinskoe Obozrenie) ISSN 2587-6821 (Print), 2686-9918 (Online)

Modern patient management with low back pain

VAK

Scopus

E-libraryDimensions

russian citation indexULRICHS

roaddoaj

CyberleninkaGoogle Scholar

vinitiResearch4life

MendeleyScilit

РГБWhite list




Open accessCrossrefAntiplagiat

RMJ.ru




DOI: 10.32364/2587-6821-2021-5-10-659-667

N.V. Pizova

Yaroslavl State Medical University, Yaroslavl, Russian Federation

Low back pain (LBP) is one of the most common pathologies of the musculoskeletal system worldwide. The article presents data on the main causes of LBP (mechanical, non-mechanical and visceral), the importance of differential diagnosis concerning possible causal factors, taking into account the presence of so-called red and yellow flags. The article also notes the fact of increased pain in the lower back and neck revealed in a number of studies in the conditions of COVID-19 and lists the main possible causes of this phenomenon. The expediency of an integrated approach to patient management with acute and chronic LBP, given the principles of evidence-based medicine, is substantiated. Drug therapy means are characterized, and data are presented indicating complex drugs’ efficacy, including those based on NSAIDs with a proven analgesic effect (diclofenac) and B vitamins. The importance of maintaining the physical activity of patients with both acute and chronic LBP and the  ability of some non-pharmacological pain therapy methods (manual therapy, Kinesio taping, etc.) to reduce pain and fear of movement are noted.

Keywords: low back pain, red flags, differential diagnosis, treatment, NSAIDs, B vitamins.

For citation: Pizova N.V. Modern patient management with low back pain. Russian Medical Inquiry. 2021;5(10):659–667 (in Russ.). DOI: 10.32364/2587-6821-2021-5-10-659-667.

About the author:

Natalia V. Pizova — Dr. Sc. (Med.), Professor of the Department of Nervous Diseases and Medical Genetics, Yaroslavl State Medical University; 5, Revolutsionnaya str., Yaroslavl, 150000, Russian Federation; ORCID iD 0000-0002-7465-0677.

Contact information: Natalia V. Pizova, e-mail: pizova@yandex.ru.

Financial Disclosure: the author has no a financial or property interest in any material or method mentioned.

There is no conflict of interests.

Received 03.08.2021.

Revised 26.08.2021.

Accepted 20.09.2021.

References
1. Hoy D., Bain C., Williams G. et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028–2037. DOI: 10.1002/art.34347.
2. Manchikanti L., Singh V., Falco F.J.E. et al. Epidemiology of low back pain in adults. Neuromodulation. 2014;17(Suppl 2):3–10. DOI: 10.1111/ner.12018.
3. Michaleff Z.A., Kamper S.J., Maher C.G. et al. Low back pain in children and adolescents: a systematic review and meta-analysis evaluating the effectiveness of conservative interventions. Eur Spine J. 2014;23(10):2046–2058. DOI: 10.1007/s00586-014-3461-1.
4. Scott N.A., Moga C., Harstall C. Managing low back pain in the primary care setting: the know-do gap. Pain Res Manag. 2010;15(6):392–400. DOI: 10.1155/2010/252695.
5. Global Burden of Disease, Injury Incidence, Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–1602. DOI: 10.1016/S0140-6736(16)31678-6.
6. Shiri R., Falah-Hassani K., Heliövaara M. et al. Risk Factors for low back pain: a population-based longitudinal study. Arthritis Care Res (Hoboken). 2019;71(2):290–299. DOI: 10.1002/acr.23710.
7. Koes B.W., van Tulder M.W., Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332(7555):1430–1434. DOI: 10.1136/bmj.332.7555.1430.
8. Hooten W.M., Cohen S.P. Evaluation and treatment of low back pain: a clinically focused review for primary care specialists. Mayo Clin Proc. 2015;90(12):1699–1718. DOI: 10.1016/j.mayocp.2015.10.009.
9. Calvo-Munoz I., Gomez-Conesa A., Sanchez-Meca J. Prevalence of low back pain in children and adolescents: a meta-analysis. BMC Pediatrics. 2013;13:14. DOI: 10.1186/1471-2431-13-14.
10. Louw Q.A., Morris L.D., Grimmer-Somers K. The prevalence of low back pain in Africa: a systematic review. BMC Musculoskelet Disord. 2007;8:105. DOI: 10.1186/1471-2474-8-105.
11. Lemeunier N., Leboeuf-Yde C., Gagey O. The natural course of low back pain: a systematic critical literature review. Chiropract Man Ther. 2012;20:33. DOI: 10.1186/2045-709X-20-33.
12. Hoy D., March L., Brooks P. et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73:968–974. DOI: 10.1136/annrheumdis-2013-204428.
13. Maniadakis N., Gray A. The economic burden of back pain in the UK. Pain. 2000;84:95–103. DOI: 10.1016/S0304-3959(99)00187-6.
14. Anema J.R., Schellart A.J., Cassidy J.D. et al. Can cross country differences in return-to-work after chronic occupational back pain be explained? An exploratory analysis on disability policies in a six country cohort study. J Occup Rehabil. 2009;19:419–426. DOI: 10.1007/s10926-009-9202-3.
15. Haldeman S., Kopansky-Giles D., Hurwitz E.L. et al. Advancements in the Management of Spine Disorders. J Manipulative Physiol Ther. 2012;26(2):263–280. DOI: 10.1016/j.berh.2012.03.006.
16. Dagenais S., Caro J., Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8–20. DOI: 10.1016/j.spinee.2007.10.005.
17. Martin B.I., Deyo R.A., Mirza S.K. et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299(6):656–664. DOI: 10.1001/jama.299.6.656.
18. Vassilaki M., Hurwitz E.L. Insights in public health: perspectives on pain in the low back and neck: global burden, epidemiology, and management. Hawaii Med J. 2014;73(4):122–126.
19. Carragee E.J. Persistent low back pain. N Engl J Med. 2005;352(18):1891–1898. DOI: 10.1056/NEJMcp042054.
20. Hartvigsen J., Lings S., Leboeuf-Yde C., Bakketeig L. Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies. Occup Environ Med. 2004;61:e2.
21. Yang H., Haldeman S., Lu M.L., Baker D. low back pain prevalence and related workplace psychosocial risk factors: a study using data from the 2010 National Health Interview Survey. J Manipulative Physiol Ther. 2016;39(7):459–472. DOI: 10.1016/j.jmpt.2016.07.004.
22. Dionne C.E., Dunn K.M., Croft P.R. et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine. 2008;33:95–103. DOI: 10.1097/BRS.0b013e31815e7f94.
23. Jarvik J., Deyo R. Diagnostic Evaluation of Low Back Pain with Emphasis on Imaging. Ann Intern Med. 2002;137:586–597. DOI: 10.7326/0003-4819-137-7-200210010-00010.
24. Will J.S., Bury D.C., Miller J.A. Mechanical Low Back Pain. Am Fam Physician. 2018;98(7):421–428.
25. Deyo R.A., Weinstein J.N. Low back pain. N Engl J Med. 2001;344:363–370. DOI: 10.1056/NEJM200102013440508.
26. Maher C., Underwood M., Buchbinder R. Non-specific low back pain. Lancet. 2017;389:736–747. DOI: 10.1016/S0140-6736(16)30970-9.
27. Hartvigsen J., Natvig B., Ferreira M. Is it all about a pain in the back? Best Pract Res Clin Rheum. 2013;27:613–623. DOI: 10.1016/j.berh.2013.09.008.
28. Hruschak V., Flowers K.M., Azizoddin D.R. et al. Cross-sectional study of psychosocial and pain-related variables among patients with chronic pain during a time of social distancing imposed by the coronavirus disease 2019 pandemic. Pain. 2021;162:619–629. DOI: 10.1097/j.pain.0000000000002128.
29. Sagat P., Bartik P., Prieto Gonzalez P. et al. Impact of COVID-19 Quarantine on Low Back Pain Intensity, Prevalence, and Associated Risk Factors among Adult Citizens Residing in Riyadh (Saudi Arabia): A Cross-Sectional Study. Int J Environ Res Public Health. 2020;17:7302. DOI: 10.3390/ijerph17197302.
30. Nieto R., Pardo R., Sora B. et al. Impact of COVID-19 Lockdown Measures on Spanish People with Chronic Pain: An Online Study Survey. J Clin Med. 2020;9:3558. DOI: 10.3390/jcm9113558.
31. Moretti A., Menna F., Aulicino M. et al. Characterization of Home Working Population during COVID-19 Emergency: A Cross-Sectional Analysis. Int J Environ Res Public Health. 2020;17:6284. DOI: 10.3390/ijerph17176284.
32. Alzahrani H., Mackey M., Stamatakis E. et al. The association between physical activity and low back pain: A systematic review and meta-analysis of observational studies. Sci Rep. 2019;9:8244. DOI: 10.1038/s41598-019-44664-8.
33. Landmark T., Romundstad P.R., Borchgrevink P.C. et al. Longitudinal associations between exercise and pain in the general population — the HUNT pain study. PLoS ONE. 2013;8:e65279. DOI: 10.1371/journal.pone.0065279.
34. Crofford L.J. Psychological aspects of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2015;29:147–155. DOI: 10.1016/j.berh.2015.04.027.
35. Delitto A., George S.Z., Van Dillen L. et al. Orthopaedic Section of the American Physical Therapy Association. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1–A57. DOI: 10.2519/jospt.2012.42.4.A1.
36. Costa L.C.M., Maher C.G., Hancock M.J. et al. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184:613–624. DOI: 10.1503/cmaj.111271.
37. Pengel L.H., Herbert R.D., Maher C.G., Refshauge K.M. Acute low back pain: systematic review of its prognosis. BMJ. 2003;327. DOI: 10.1136/bmj.327.7410.323.
38. Mehling W.E., Gopisetty V., Bartmess E. et al. The prognosis of acute low back paen in primary care in the United States. A 2-year prospective cohort study. Spine. 2012;37:678–684. DOI: 10.1097/BRS.0b013e318230ab20.
39. Вауличева А.Л., Воробьева О.В. Хронизация боли в спине у мужчин трудоспособного возраста. Врач. 2010;9:47–50. [Vaulicheva A.L., Vorobeva O.V. Chronization of back pain in men of working age. Vrach. 2010;9:47–50 (in Russ.)].
40. Kolb E., Canjuga M., Bauer G.F., Läubli T. Course of back pain across 5 years: a retrospective cohort study in the general population of Switzerland. Spine (Phila Pa 1976). 2011;36(4):E268–273. DOI: 10.1097/BRS.0b013e3181f324b5.
41. Waddell G., Burton A.K. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med. 2001;51(2):124–135. DOI: 10.1093/occmed/51.2.124.
42. Downie A., Williams C.M., Henschke N. et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013;347:f7095. DOI: 10.1136/bmj.f7095.
43. Casser H.R., Seddigh S., Rauschmann M. Acute Lumbar Back Pain. Dtsch Arztebl Int. 2016;113(13):223–234. DOI: 10.3238/arztebl.2016.0223.
44. Airaksinen O., Brox J.I., Cedraschi C. et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;(Suppl 2):192–300. DOI: 10.1007/s00586-006-1072-1.
45. Schmidt C.O., Raspe H., Pfingsten M. Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine. 2007;32:2005–2011. DOI: 10.1097/BRS.0b013e318133fad8.
46. Пизова Н.В. Амбулаторное ведение пациентов с болями в нижней части спины: оптимизация тактики. Consilium Medicum. 2014;9:80–84. [Pizova N.V. Outpatient management of patients with lower back pain: tactics optimization. Consilium Medicum. 2014;9: 80–84 (in Russ.)].
47. Van der Windt D.A., Simons E., Riphagen I.I. et al. Physical examination for lumbar radiculopathy due two disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010;2:CD007431. DOI: 10.1002/14651858.CD007431.pub2.
48. Van Tulder M., Becker А., Bekkering T. et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl. 2):S169–S191. DOI: 10.1007/s00586-006-1071-2.
49. Chou R., Qaseem A., Snow V. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–491. DOI: 10.7326/0003-4819-147-7-200710020-00006.
50. Ketenci A., Zure M. Pharmacological and non-pharmacological treatment approaches to chronic lumbar back pain. Turk J Phys Med Rehabil. 2021;67(1):1–10. DOI: 10.5606/tftrd.2021.8216.
51. Пизова Н.В. Ведение пациентов с болью в нижней части спины. Медицинский совет. 2014;18:58–64. [Pizova N.V. Management of patients with pain in the lower back. Medical Council. 2014;18:58–64 (in Russ.)].
52. Foster N.E., Anema J.R., Cherkin D. et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391:2368–2383. DOI: 10.1016/S0140-6736(18)30489-6.
53. Oliveira C.B., Maher C.G., Pinto R.Z. et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27:2791–2803. DOI: 10.1007/s00586-018-5673-2.
54. Saragiotto B.T., Machado G.C., Ferreira M.L. et al. Paracetamol for low back pain. Cochrane Database Syst Rev. 2016;2016(6):CD012230. DOI: 10.1002/14651858.CD012230.
55. Chou R., Deyo R., Friedly J. et al. Systemic pharmacologic therapies for low back pain: A systematic review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166:480–492. DOI: 10.7326/M16-2458.
56. Fornari M., Robertson S.C., Pereira P. et al. Conservative treatment and percutaneous pain relief techniques in patients with lumbar spinal stenosis: WFNS spine committee recommendations. World Neurosurg X. 2020;7:100079. DOI: 10.1016/j.wnsx.2020.100079.
57. Bhatia A., Engle A., Cohen S.P. Current and future pharmacological agents for the treatment of back pain. Expert Opin Pharmacother. 2020;21:857–861. DOI: 10.1080/14656566.2020.1735353.
58. Kreiner D.S., Matz P., Bono C.M. et al. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine J. 2020;20:998–1024. DOI: 10.1016/j.spinee.2020.04.006.
59. Urquhart D.M., Hoving J.L., Assendelft W.W. et al. Antidepressants for non-specific low back pain. Cochrane Database Syst Rev. 2008;2008(1):CD001703. DOI: 10.1002/14651858.CD001703.pub3.
60. Weng C., Xu J., Wang Q. et al. Efficacy and safety of duloxetine in osteoarthritis or chronic low back pain: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2020;28:721–734. DOI: 10.1016/j.joca.2020.03.001.
61. Lussier D., Huskey A.G., Portenoy R.K. Adjuvant analgesics in cancer pain management. Oncologist. 2004;9(5):571–591. DOI: 10.1634/theoncologist.9-5-571.
62. Calderon-Ospina C.A., Nava-Mesa M.O., Arbeláez Ariza C.E. Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain Management: Systematic Review and Meta-analysis. Pain Med. 2020;21(4):766–781. DOI: 10.1093/pm/pnz216.
63. Kuhlwein A., Meyer H.J., Koehler C.O. Reduced diclofenac administration by B vitamins: Results of a randomized double-blind study with reduced daily doses of diclofenac (75 mg diclofenac versus 75 mg diclofenac plus B vitamins) in acute lumbar vertebral syndromes. Klin Wochenschr. 1990;68(2):107–115. DOI: 10.1007/BF01646857.
64. Vetter G., Brüggemann G., Lettko M. et al. Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes. Z Rheumatol. 1988;47(5):351–362.
65. Brüggemann G., Koehler C.O., Koch E.M. Results of a double-blind study of diclofenac + vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study. Klin Wochenschr. 1990;68(2):116–120. DOI: 10.1007/BF01646858.
66. Hurt J.K., Coleman J.L., Fitzpatrick B.J. et al. Prostatic acid phosphatase is required for the antinociceptive effects of thiamine and benfotiamine. PLoS One. 2012;7(10):e48562. DOI: 10.1371/journal.pone.0048562.
67. Song X.-S., Huang Z.-J., Song X.-J. Thiamine suppresses thermal hyperalgesia, inhibits hyperexcitability, and lessens alterations of sodium currents in injured, dorsal root ganglion neurons in rats. Anesthesiology. 2009;110(2):387–400. DOI: 10.1097/ALN.0b013e3181942f1e.
68. Thériault O., Poulin H., Thomas G.R. et al. Pyridoxal-5’-phosphate (MC-1), a vitamin B6 derivative, inhibits expressed P2X receptors. Can J Physiol Pharmacol. 2014;92(3):189–196. DOI: 10.1139/cjpp-2013-0404.
69. Chiang E.-P., Smith D.E., Selhub J. et al. Inflammation causes tissue-specific depletion of vitamin B6. Arthritis Res Ther. 2005;7(6):R1254–R1262. DOI: 10.1186/ar1821.
70. Erfanparast A., Tamaddonfard E. Effects of intracortical microinjection of vitamin B12 on penicillin-induced epileptiform activity in rats. Acta Neurobiol Exp (Wars). 2015;75(2):200–207.
71. Hosseinzadeh H., Moallem S.A., Moshiri M. et al. Anti-nociceptive and anti-inflammatory effects of cyanocobalamin (vitamin B12) against acute and chronic pain and inflammation in mice. Arzneimittelforschung. 2012;62(7):324–329. DOI: 10.1055/s-0032-1311635.
72. Moallem S.A., Hosseinzadeh H., Farahi S. A study of acute and chronic anti-nociceptive and anti-inflammatory effects of thiamine in mice. Iran Biomed J. 2008;12(3):173–178.
73. McCarty M.F. High-dose pyridoxine as an "anti-stress" strategy. Med Hypotheses. 2000;54(5):803–807. DOI: 10.1054/mehy.1999.0955.
74. Lerner V., Miodownik C., Kaptsan A. et al. Vitamin B6 treatment for tardive dyskinesia: A randomized, double-blind, placebo-controlled, crossover study. J Clin Psychiatry. 2007;68(11):1648–1654. DOI: 10.4088/JCP.v68n1103.
75. Friso S., Jacques P.F., Wilson P.W. et al. Low circulating vitamin B(6) is associated with elevation of the inflammation marker C-reactive protein independently of plasma homocysteine levels. Circulation. 2001;103(23):2788–2791. DOI: 10.1161/01.CIR.103.23.2788.
76. Menezes R.R., Godin A.M., Rodrigues F.F. et al. Thiamine and riboflavin inhibit production of cytokines and increase the anti-inflammatory activity of a corticosteroid in a chronic model of inflammation induced by complete Freund’s adjuvant. Pharmacol Rep. 2017;69(5):1036–1043. DOI: 10.1016/j.pharep.2017.04.011.
77. Onk D., Mammadov R., Suleyman B. et al. The effect of thiamine and its metabolites on peripheral neuropathic pain induced by cisplatin in rats. Exp Anim. 2018;67(2):259–269. DOI: 10.1538/expanim.17-0090.
78. Lettko M., Bartoszyk G.D. Reduced need for diclofenac with concomitant administration of pyridoxine and other B vitamins. Ann NY Acad Sci. 1990;585:510–512. DOI: 10.1111/j.1749-6632.1990.tb28090.x.
79. Khan T.A., Ahmad A., Haider I.Z. Low dose diclofenac sodium with vitamin-B complex compared with diclofenac alone. Professional Med J. 2008;15:440–444. DOI: 10.29309/TPMJ/2008.15.04.2864.
80. Инструкция по медицинскому применению лекарственного препарата Нейродикловит (Электронный ресурс.) URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=8b03a906–13ed-425f-970d-2cda082d631c t= (дата обращения: 24.05.2021). [Instructions for the medical use of the drug Neurodiclovit. (Electronic resource.) URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=8b03a906–13ed-425f-970d-2cda082d631c t= (access date: 05.24.2021) (in Russ.)].
81. Бойко А.Н., Батышева Т.Т., Камчатнов П.Р. и др. Нейродикловит: возможность применения у пациентов с болью в спине. Фарматека. 2010;7(201):63–69. [Boyko A.N., Batysheva T.T., Kamchatnov P.R. et al. Neurodiclovit: the possibility of use in patients with back pain. Farmateka. 2010;7(201):63–69 (in Russ.)].
82. Юдельсон Я.Б., Рачин А.Л., Белогорохов О.О. Эффективность и безопасность применения препарата нейродикловит при дорсалгии. Фарматека. 2008;20:132–136. [Judel’son Ja.B., Rachin A.P., Belogorohov O.O. The efficacy and safety of using the drug neurodiclovit for dorsalgia. Farmateka. 2008;20;132–136 (in Russ.)].
83. Ковальчук В.В., Аманова Э.О., Галкин А.С. и др. Комбинированные препараты: возможности повышения эффективности и безопасности традиционной терапии боли в спине. Эффективная фармакотерапия. 2017;19:80–88. [Kovalchuk V.V., Amanova E.O., Galkin A.S., et al. Combination Drugs: an Opportunity for Increasing Efficacy and Safety for Routine Therapy of Back Pain. Effective Pharmacotherapy. 2017;19:80–88 (in Russ.)].
84. Хайбуллина Д.Х., Максимов Ю.Н., Девликамова Ф.И. Хроническая скелетно-мышечная боль в практике невролога. Медицинский совет. 2021;(2):22–28. DOI: 10.21518/2079-701X-2021-2-22-28. [Khaibullina D.Kh., Maksimov Y.N., Devlikamova F.I. Chronic musculoskeletal pain in neurological practice. Meditsinskiy sovet. 2021;(2):22–28 (in Russ.)]. DOI: 10.21518/2079-701X-2021-2-22-28.
85. Corp N., Mansell G., Stynes S. et al. Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. Eur J Pain. 2021;25(2):275–295. DOI: 10.1002/ejp.1679.
86. O’Keeffe M. Non-pharmacological treatment of low back pain in primary care. Drug Ther Bull. 2019;57:104–108. DOI: 10.1136/dtb.2018.000015.
87. Tagliaferri S.D., Miller C.T., Owen P.J. et al. Domains of chronic low back pain and assessing treatment effectiveness: A clinical perspective. Pain Pract. 2020;20:211–225. DOI: 10.1111/papr.12846.

License Creative Commons
This work is licensed under a Creative Commons «Attribution» 4.0 License.


Previous article
Next article