Ведение пациентов с хронической неспецифической болью в спине (НБС) – актуальная проблема не только медицины, но и всего со- временного общества, так как с ней связаны значительные социально-экономические потери.
В лекции представлены наиболее распространенные анатомические источники НБС, причины развития хронической НБС, вопросы дифференциальной диагностики. Большое внимание уделено основным принципам терапии хронической НБС: лекарственному лечению, кинезиотерапии и психологическим методам. Приведены клинические наблюдения, демонстрирующие эффективность мультимодального комплексного подхода к лечению НБС, основанного на использовании когнитивно-поведенческой терапии, образовательных программ и кинезиотерапии, а также тестовые задания для самоконтроля.
Идентификаторы и классификаторы
Боль в шее и спине – одна из самых распространенных жалоб в общей медицинской практике. Наиболее часто встречается поясничная боль, на долю которой приходится 10% в структуре инвалидизации, вызванной различными заболеваниями [1, 2]. Боль в поясничной области занимает первое место среди всех неинфекционных заболеваний по показателю, отражающему количество лет жизни, потерянных вследствие стойкого ухудшения здоровья [1, 2]. Боль в спине обусловливает значительные социально-экономические потери в связи с временной утратой трудоспособности.
Список литературы
1. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Aug 22;386(9995):743-800. doi: 10.1016/S0140- 6736(15)60692-4. Epub 2015 Jun 7.
2. GBD 2019 Diseases and InjuriesCollaborators. Global burden of 369 diseases and injuries in 204м countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020 Oct 17;396(10258): 1204-1222. doi: 10.1016/S0140-6736 (20)30925-9.
3. Koes BW, van Tulder M, Lin CW, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010 ;19(12):2075-94. doi: 10.1007/ s00586-010-1502-y. Epub 2010 Jul 3.
4. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for , Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14.
5. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017 Feb 18;389(10070):736-747. doi: 10.1016/ S0140-6736(16)30970-9. Epub 2016 Oct 11.
6. Парфенов ВА, Исайкин АИ. Боли в нижней части спины: мифы и реальность. Москва: ИМА-ПРЕСС; 2016. 104 с. [Parfenov VA, Isaikin AI. Low Back pain: Myths and reality. Moscow: IMA-PRESS; 2016. 104 p.].
7. Парфенов ВА, Исайкин АИ. Боли в поясничной области. Библиотека практического врача. Серия «Неврология». Москва: МЕДпресс-информ; 2018. [Parfenov VA, Isaikin AI. Pain in the lumbar region. The library of a practical doctor. The series “Neurology” Moscow: MEDpressinform; 2018].
8. Подчуфарова ЕВ, Яхно НН. Боль в спине. Москва; 2010. 368 с. [Podchufarova EV, Yakhno NN. Back pain. Moscow; 2010. 368 p.].
9. Low Back Pain and Sciatica in Over 16s: Assessment and Management. London: National Institute for Health and Care Excellence (UK); 2016 Nov. National Institute for Health and Care Excellenc:
Clinical Guidelines.
10. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain:
Cochrane systematic review and metaanalysis. Cochrane Database Syst Rev. 2014 Sep 2;2014(9):CD000963. doi: 10.1002/ 14651858.CD000963.pub3.
11. Парфенов ВА, Яхно НН, Давыдов ОС и др. Хроническая неспецифическая
(скелетно-мышечная) поясничная боль. Рекомендации Российского общества мпо изучению боли (РОИБ). Неврология, нейропсихиатрия, психосоматика.
2019;11(2S):7-16. [Parfenov VA, Yakhno NN, Davydov OS, et al. Chronic nonspecific (musculoskeletal) back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(Suppl. 2): 7-16. (In Russ.).] doi: 10.14412/2074-2711-2019-2S-7-16.
12. Kuritzky L, Samraj GP Nonsteroidal antiinflammatory drugs in the treatment of low back pain. J Pain Res. 2012:5: 579-90. doi: 10.2147/JPR.S6775. Epub 2012 Nov 28.
13. Насонов ЕЛ, Яхно НН, Каратеев АЕ и др. Общие принципы лечения скелетно-мышечной боли: междисциплинарный консенсус. Научно-практическая ревматология. 2016;54(3):247-265. [Nasonov EL, Yakhno NN, Karateev AE, et al. General principles of treatment of musculoskeletal pain: interdisciplinary consensus. Nauchno-prakticheskaya revmatologiya. 2016;54(3):247-265. (In Russ.)].
14. 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 Apr 4; 166(7):480-492. doi: 10.7326/M16-2458. Epub 2017 Feb 14.
15. Cashin AG, Wand BM, O’Connell NE, et al. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2023 Apr 4;4(4):CD013815. doi: 10.1002/14651858.CD013815.pub2.
16. Enthoven WT, Roelofs PD, Deyo RA, et al. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev. 2016 Feb 10;2(2): CD012087. doi: 10.1002/14651858. CD012087.
17. Van Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003;2003(2):CD004252. doi: 10.1002/14651858.CD004252.
18. Staiger TO, Gaster B, Sullivan MD, Deyo RA. Systematic review of antidepressantsin the treatment of chronic low back pain. Spine (Phila Pa 1976). 2003 Nov 15; 28(22):2540-5. doi: 10.1097/01.BRS. 0000092372.73527.BA.
19. Kuijpers T, van Middelkoop M, Rubinstein SM, et al. A systematic review on the effectiveness of pharmacological interventions for chronic non-specific low-back pain. Eur Spine J. 2011 Jan;20(1):40-50. doi: 10.1007/ s00586-010-1541-4. Epub 2010 Jul 31.
20. Feise RJ, Mathieson S, Kessler RS, et al. Benefits and harms of treatments for chronic nonspecific low back pain witout radiculopathy: systematic review and meta-analysis. Spine J. 2023 May;23(5):629-641. doi: 10.1016/j.spinee.2022. 11.003. Epub 2022 Nov 17.
21. Chou R, Hashimoto R, Friedly J, et al. Pain Management Injection Therapies for Low Back Pain. Agency for Health-care Research and Quality (US); 2015 Mar 20.
22. Geneen LJ, Moore RA, Clarke C. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017 Apr 24;4(4):CD011279. doi: 10.1002/
14651858.CD011279.pub3.
23. Niederer D, Mueller J. Sustainability effects of motor control stabilisation exercises on pain and function in chronic nonspecific low back pain patients: A syste- matic review with meta-analysis and meta-regression. PLoS One. 2020 Jan 15;15(1):e0227423. doi: 10.1371/journal.pone.0227423. eCollection 2020.
24. Hayden JA, Wilson MN, Stewart S, et al. Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials. Br J Sports Med. 2020 Nov;54(21):1277-1278. doi: 10.1136/bjsports-2019-101205. Epub 2019 Nov 28.
25. Pan L, Li Y, Gao L, et al. Effects of Kinesio Taping for Chronic Nonspecific Low Back Pain: A Systematic Review and Meta-analysis. Altern Ther Health Med. 2023 Sep; 29(6):68-76.
26. Saragiotto BT, Maher CG, Yamato TP, et al. Motor Control Exercise for Nonspecific Low Back Pain: A Cochrane Review. Spine (Phila Pa 1976). 2016 Aug 15;41(16):1284-1295. doi: 10.1097/BRS. 0000000000001645.
27. Owen PJ, Miller CT, Mundell NL, et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2020 Nov;54(21):1279-1287.
doi: 10.1136/bjsports-2019-100886. Epub 2019 Oct 30.
28. Hayden JA, Ellis J, Ogilvie R, et al. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother. 2021 Oct;67(4):252-262. doi: 10.1016/j.jphys. 2021.09.004. Epub 2021 Sep 16.
29. Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015 Dec;29(12): 1155-67. doi: 10.1177/0269215515570379. Epub 2015 Feb 13.
30. Suh JH, Kim H, Jung GP, et al. The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine
(Baltimore). 2019 Jun;98(26):e16173. doi: 10.1097/MD.0000000000016173.
31. Akhtar MW, Karimi H, Gilani SA. Effectiveness of core stabilization exercises and routine exercise therapy in management pain in chronic non-specific low back pain: A randomized controlled clinical trial. Pak J Med Sci. 2017 Jul-Aug;33(4):1002- . doi: 10.12669/pjms.334.12664.
32. Toprak Celenay C, Еzer Kaya D. An 8-week thoracic spine stabilization exercise program improves postural back pain, spine alignment, postural sway, and core endurance in university students: a randomized controlled study. Turk J MedSci. 2017 Apr 18;47(2):504-513. doi: 10.3906/sag-1511-155.
33. Kim CR, Park DK, Lee ST, Ryu JS. Electromyographic Changes in Trunk Muscles During Graded Lumbar Stabilization Exercises. PM R. 2016 Oct; 8(10):979-989. doi: 10.1016/j.pmrj. 2016.05.017. Epub 2016 Jun 16.
34. Lee HS, Kim DJ, Oh Y, et al. The effect of individualized gradable stabilization exercises in patients with chronic low back pain: case-control study. J Back Musculoskelet Rehabil. 2016 Jun 17;29(3):603-10. doi: 10.3233/BMR-160724.
35. Vera-Garcia FJ, Irles-Vidal B, Prat-Luri A, et al. Progressions of core stabilization exercises based on postural control challenge assessment. Eur J Appl Physiol. 2020 Mar;120(3):567-577. doi: 10.1007/ s00421-020-04313-9. Epub 2020 Feb 11.
36. Hayden JA, Ellis J, Ogilvie R, et al. Some types of exercise are more effective than others in people with chronic low back pain:a network meta-analysis. J Physiother. 2021 Oct;67(4):252-262. doi: 10.1016/ j.jphys.2021.09.004. Epub 2021 Sep 16.
37. Sonne M, Villalta DL, Andrews DM. Development and evaluation of an office ergonomic risk checklist: ROSA-rapid office strain assessment. Appl Ergon. 2012 Jan; 43(1):98-108. doi: 10.1016/j.apergo. 2011.03.008. Epub 2011 May 6.
38. Хабиров ФА, Хабирова ЮФ. Боль в шее и спне: руководство для врачей. Казань: Медицина; 2014. 504 c. [Khabirov FA, Khabirova YuF. Neck and Back pain: a guide for doctors. Kazan’: Meditsina; 2014. 504 p.].
39. Shariat A, Cleland JA, Danaee M, et al. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J Phys Ther. 2018 Mar-Apr;22(2):144-153. doi: 10.1016/j.bjpt.2017.09.003. Epub 2017 Sep 6.
40. O’Connor SR, Tully MA, Ryan B, et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Arch Phys Med Rehabil. 2015 Apr;96(4): 724-734.e3. doi: 10.1016/j.apmr.2014.12.003. Epub 2014 Dec 19.
41. Sitthipornvorakul E, Klinsophon T, Sihawong R, Janwantanakul P. The effects of walking intervention in patients with chronic low back pain: A meta-analysis of randomized
controlled trials. Musculo- skelet Sci Pract. 2018 Apr:34:38-46. doi: 10.1016/ j.msksp.2017.12.003. Epub 2017 Dec 12.
42. Vanti C, Andreatta S, Borghi S, et al. The effectiveness of walking versus exercise on pain and function in chronic low back : a systematic review and meta-analysis of randomized trials. Disabil Rehabil. 2019 Mar;41(6):622-632. doi: 10.1080/09638288. 2017.1410730. Epub 2017 Dec 5.
43. Bullo V, Gobbo S, Vendramin B, et al. Nordic Walking Can Be Incorporated in the Exercise Prescription to Increase Aerobic Capacity, Strength, and Quality of Life for Elderly: A Systematic Review and Meta- Analysis. Rejuvenation Res. 2018 Apr;21(2): 141-161. doi: 10.1089/rej.2017.1921. Epub 2017 Nov 20.
44. Huang YH, Fang IY, Kuo YL. The Influence of Nordic Walking on Spinal Posture, Community-Dwelling Older Adults: A Pilot Study. Healthcare (Basel). 2021 Sep 30;9(10):
1303. doi: 10.3390/healthcare9101303.
45. Park HS, Lee SN, Sung DH, et al. The effect of power nordic walking on spine deformation and visual analog pain scale in women with low back pain. J Phys Ther Sci. 2014 Nov;26(11):1809-12. doi: 10.1589/jpts.26.1809. Epub 2014 Nov 13.
46. Williams ACC, Fisher E, Hearn L, Eccleston C. Psychological therapies for themanagement of chronic pain (excluding headache) in adults. Cochrane Database Syst
Rev. 2020 Aug 12;8(8):CD007407. doi: 10.1002/14651858.CD007407.pub4.
47. Richmond H, Hall A, Copsey B, et al. The effectiveness of cognitive behavioural treatment for non-specific low back pain: A systematic review and meta-analysis. PLoS One. 2015 Aug 5;10(8):e0134192. doi: 10.1371/journal.pone.0134192. eCollection 2015.
48. Kerns RD, Sellinger J, Goodin BR. Psychological treatment of chronic pain. Annu Rev Clin Psychol. 2011:7:411-34. doi: 10.1146/annurev-clinpsy-090310-120430.
49. Hernandez-Lucas P, Leiros-Rodriguez R, Lopez-Barreiro J, Garcia-Soidan JL. Is the combination of exercise therapy and health education more effective than usual medical care in the prevention of non-specific back pain? A systematic review with meta-analysis. Ann Med. 2022 Dec;54(1): 3107-3116. doi: 10.1080/07853890.2022. 2140453.
50. Wieland LS, Skoetz N, Pilkington K, et al. Yoga for chronic non-specific low back pain. Cochrane Database Syst Rev. 2022 Nov 18;11(11):CD010671. doi: 10.1002/ 14651858.CD010671.pub3.
51. Resende L, Merriwether E, Rampazo EP, et al. Meta-analysis of transcutaneous electrical nerve stimulation for relief of spinal pain. Eur J Pain. 2018 Apr;22(4): 663-678. doi: 10.1002/ejp.1168. Epub 2017 Dec 27.
52. Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review andmeta-analysis of randomised controlled trials. BMJ. 2019;364:l689. Published 2019 Mar 13. doi:10.1136/bmj.l689
53. Liu L, Skinner M, McDonough S, et al. Acupuncture for Low Back Pain: An Overview of Systematic Reviews. Evid Based Complement Alternat Med. 2015:2015:328196. doi: 10.1155/2015/328196. Epub 2015 Mar 4.
54. Hutchinson A, Ball S, Andrews J, Jones GG. The effectiveness of acupuncturein treating chronic non-specific low back pain: a systematic review of the litera- ture. J OrthopSurg Res. 2012 Oct 30:7:36. doi: 10.1186/ 1749-799X-7-36.
55. Saltychev M, Eskola M, Laimi K. Lumbar fusion compared with conservative treatment in patients with chronic low back pain: a meta-analysis. Int J Rehabil Res. 2014 Mar;37(1):2-8. doi: 10.1097/MRR. 0b013e328363ba4b.
56. Furlan AD, Giraldo M, Baskwill A, et al. Massage for low-back pain. Cochrane Database Syst Rev. 2015 Sep 1;2015(9): CD001929. doi: 10.1002/14651858. CD001929.pub3.
57. Евзиков ГЮ, Егоров ОЕ, Розен АИ. Радиочастотная денервация в лечении болевого синдрома при патологии крестцово-подвздошного сочленения. Нейро- хирургия. 2015;(2):80-85. [Evzikov GYu, Egorov OE, Rozen AI.Radiofrequency denervation in the treatment of pain syndrome in pathology of the sacroiliac joint. Neirokhirurgiya. 2015;(2): 80-85. (In Russ.)].
58. Maas ET, Juch JNS, Ostelo R, et al. Cost-Effectiveness of Radiofrequency Denervationfor Patients With Chronic Low Back Pain: The MINT Randomized Clinical Trials. Value Health. 2020 May;23(5):585-594. doi: 10.1016/j.jval.2019.12.009. Epub 2020 Feb 29.
Издательство
- Издательство
- ИМА-ПРЕСС
- Регион
- Россия, Москва
- Почтовый адрес
- 115093, г Москва, Даниловский р-н, Партийный пер, д 1 к 58 стр 2, офис 45
- Юр. адрес
- 115093, г Москва, Даниловский р-н, Партийный пер, д 1 к 58 стр 2, офис 45
- ФИО
- Титова Марина Николаевна (ГЕНЕРАЛЬНЫЙ ДИРЕКТОР)