Musculoskeletal pain syndromes are one of the most common causes of disability and referral to a medical specialist. Seven million consultations for lumbosacral pain are annually carried out in the United Kingdom.Examination of patients with back pain. Three levels of health care delivered to patients with back pain in the United Kingdom may be arbitrarily identified. Level 1 is outpatient: a general practitioner jointly with a manipulative therapist, a physiotherapist, a rehabilitation specialist, and mid-level health workers render care to patients with insignificant and mild pain syndrome; Level 2 is also outpatient, which involves the participation of a hospital or multidisciplinary team consultant, for example, in a musculoskeletal pain service or a specialized pain center; Level 3 is to deliver care at neurosurgical or orthopedic hospital, by applying invasive interventions. Acute back pain is a benign condition in the vast majority of cases; there is no need for additional instrumental and laboratory studies; but spinal X-ray study, computed tomography (СT scan), or magnetic resonance imaging (MRI), general blood and urine tests are required when marked neurological and somatic disorders are present.Management of patients with acute lumbosacral pain is to inform a patient about the benign nature of the disease; to exclude bed rest; to explain the need to maintain normal activity; to train how to correctly lift weights and to maintain normal posture; to refer for manual and exercise therapy in order to return to normal motor activity; to use proven effective medication. In most cases, acute back pain goes away spontaneously for a short period of time; an active treatment approach is considered to be optimal. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are used for analgesia if required. Patients who show no improvement after 4 weeks of treatment need rescreening for markers of potentially dangerous spinal diseases, as well as determination of the signs of psychosocial ill-being and correction of therapy with consideration for identified disorders.Management of patients with subacute and chronic pain (persisting for >6 weeks, but <1 year) involves the regular reconsideration of whether the diagnosis of nonspecific back pain is correct in order to rule out possible specific causes. MRI is indicated when a patient is decided to be referred for surgical treatment or there is presumptive evidence for spinal tumors, infectious, inflammatory, or traumatic injury, or cauda equina syndrome. It is optimal to start treatment with a program of therapeutic exercises, manual therapy, or acupuncture. Drug therapy encompasses NSAIDs, acetaminophen, and opioids to treat intensive pain syndrome.

Among nonsteroidal anti-inflammatory drugs, meloxicam has a slight effect on blood pressure (BP). Objective: to study the efficacy and safety of amelotex in acute musculoskeletal pain in the lumbosacral region and essential hypertension (EH). Subjects and methods. An open-label comparative trial of the safety and efficacy of amelotex (meloxicam injectable dosage form) in an intramuscular dose of 15 mg/day and diclofenac sodium in an intramuscular dose of 75 mg/day was conducted in 120 patients with acute muscu- loskeletal pain in the lumbosacral region and grade 1 EH. Results. Amelotex was as effective as diclofenac sodium in reducing the intensity of pain and the degree of vertebral syndrome and decreasing the restricted daily activity of patients with acute lumbalgia and concomitant grade 1 EH. Ten-day use of amelotex in the above dose caused no significant BL elevation. Conclusion. Amelotex was observed to be highly effective and well tolerated in patients with grade 1 EH who were treated for acute muscu- loskeletal pain in the back.

A total of 64 patients with musculoskeletal pain syndromes in the lumbosacral area for more than three months were studied. Patients were divided into age groups: 30–50 years (41 patients) and 51–60 years (23 patients). The reference group consisted of 20 healthy volunteers comparable in terms of gender, age, and level of education. Patients underwent neurological, neuro-orthopedic, clinical-pathopsychological, and neuropsychological investigations. Complaints of difficulty with mental concentration were present in 17.3% of patients and problems with remembering information in 20.2%. Both groups of patients with chronic pain showed mild neurodynamic impairments. As compared with healthy subjects, they had significantly worse performance in tests assessing memory (delayed reproduction in the 12-word test), attention, mental flexibility, and visuomotor coordination (the sequential number-letter combination test, digit symbol substitution test, and, in younger patients, the forward and backward number series repetition test). Cognitive functions in younger patients were affected by the sensory-discriminant (intensity) and affective-motivational (negative emotions, particularly anxiety) characteristics of pain. Cognitive functions in older patients were affected by the affective-motivational (anxiety, level of psychoemotional distress) and cognitive (level of catastrophization) components of pain. Treatment directed at correcting the peripheral sources of pain and emotional disorders (rational psychotherapy, tranquilizers, antidepressants) could potentially have positive effects on cognitive functions in patients with chronic pain.

In most cases, spinal nerve root lesion is due to vertebral causes, such as disk herniation, degenerative changes in the intervertebral joints, and a narrow vertebral canal. The paper considers the pathogenetic mechanisms responsible for the development of discogenic radiculopathy and its associated pain syndrome and main approaches to its diagnosis and treatment. Some attention is given to therapy for neuropathic pain syndrome.

The paper describes the current views of the development of back pain and management tactics in patients with this pain that is periodically observed in almost everyone. Back pain may be induced by changes in the vertebral column, diseases of muscles, involvement of the roots and peripheral nerves, pathology of thoracic, abdominal, and small pelvic viscera, and psychogenic disorders. Musculoskeletal disorders are the most common causes of back pain. The mechanisms of development of back pain are presently the subject of active investigations. Back pain is indubitably a multidisciplinary problem, which is especially confirmed by the fact that there are different approaches to revealing the source of pain and there is a great deal of treatments for this condition. Unlike chronic pain, acute musculoskeletal pain in the back is a benign and generally self-limited condition. To set off nonspecific back pain, i.e. pain associated with musculoskeletal disorders without signs of involvement of cervical, thoracic, lumbar, and sacral roots and specific spinal lesions (spondylolisthesis, osteoporosis, tumors, inflammatory spondyloarthropathies, etc.) is convenient and warranted in most cases when a patient with acute back pain is examined by a general practitioner. The paper gives the data of the current guidelines for the management of patients with nonspecific back pain

The authors have studied cognitive functions and influencing factors in 64 patients with chronic low back pain. All patients have been examined using neurologic, neuroorthopedic, pathopsychological and neuropsychological methods. Patients have been divided into 2 groups according to their age: group 1 (aged 30-50 years) and group 2 (aged 51-60 years). Healthy controls were matched to patients for age, sex and education. Significant differences in neuropsychological testing, i.e. mental flexibility, delayed memory, psychomotor speed, which referred to the subtle cognitive impairment with executive function disturbances, were found in both groups of patients with chronic low back pain as compared to pain-free adults. Sensory-discriminative (pain intensity) and affective-emotional (negative emotions, in particular, anxiety) characteristics had the effect on cognitive functions in younger patients without depressive symptoms. Affective-emotional (anxiety, psychological distress) and cognitive characteristics (i.e. catastrophising) contributed to the cognitive disturbances in older patients.

Chronic pain syndromes comprise a heterogeneous group of very common clinical conditions having important medical and social implications. The author briefly reviews evolution of the concepts of mechanisms and characteristics of neuropathic, nociceptic, and psychogenic pain and current approaches to the diagnosis and treatment of neuropathic pain syndromes and musculo-skeletal pains. The recommended therapeutic modalities for patients with chronic pains are based on the results of original studies conducted in the Department of Neural Diseases, I. M Sechenov Moscow Medical Academy, during the last years and recent data obtained in foreign clinics.

European Journal of PainVolume 10, Issue S1 p. S108-S108 404 ANALGESIC EFFICACY AND SAFETY OF LORNOXICAM QUICK RELEASE FORMULATION IN A RANDOMISED, DOUBLE-BLIND TRIAL IN ACUTE LOW BACK PAIN N.N. Yakhno, N.N. Yakhno Department of Neurology, Moscow Medical Academy, MoscowSearch for more papers by this authorE.V. Podchufarova, E.V. Podchufarova Department of Neurology, Moscow Medical Academy, MoscowSearch for more papers by this authorA.B. Guekht, A.B. Guekht Department of Neurology and Neurosurgery, Russian State Medical University, MoscowSearch for more papers by this authorA.A. Skoromets, A.A. Skoromets Department of Neurology and Neurosurgery, St. Petersburg State Medical University named after I.P. Pavlov, St. PetersburgSearch for more papers by this authorN.N. Spirin, N.N. Spirin Department of Neurology and medical genetics with training course of neurosurgery, Yaroslavl's State Medical Academy, YaroslavlSearch for more papers by this authorE. Strachunskaya, E. Strachunskaya Neurology and Psychiatry of Postgraduate training faculty, Smolensk State Medical Academy, SmolenskSearch for more papers by this authorA.P. Ternavsky, A.P. Ternavsky Clinical Trial Department, Municipal Clinical Hospital #13, Moscow, RussiaSearch for more papers by this author N.N. Yakhno, N.N. Yakhno Department of Neurology, Moscow Medical Academy, MoscowSearch for more papers by this authorE.V. Podchufarova, E.V. Podchufarova Department of Neurology, Moscow Medical Academy, MoscowSearch for more papers by this authorA.B. Guekht, A.B. Guekht Department of Neurology and Neurosurgery, Russian State Medical University, MoscowSearch for more papers by this authorA.A. Skoromets, A.A. Skoromets Department of Neurology and Neurosurgery, St. Petersburg State Medical University named after I.P. Pavlov, St. PetersburgSearch for more papers by this authorN.N. Spirin, N.N. Spirin Department of Neurology and medical genetics with training course of neurosurgery, Yaroslavl's State Medical Academy, YaroslavlSearch for more papers by this authorE. Strachunskaya, E. Strachunskaya Neurology and Psychiatry of Postgraduate training faculty, Smolensk State Medical Academy, SmolenskSearch for more papers by this authorA.P. Ternavsky, A.P. Ternavsky Clinical Trial Department, Municipal Clinical Hospital #13, Moscow, RussiaSearch for more papers by this author First published: 13 January 2012 https://doi.org/10.1016/S1090-3801(06)60407-2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume10, IssueS1September 2006Pages S108-S108 RelatedInformation

We examined 143 patients, aged 18-65 years, with chronic low back pain, in 78 of patients diagnosed as chronic somatoform pain disorder (CSPD)--ICD-10 F45.4--and in 65 as chronic pain syndrome (CPS) caused by spine pathology (M48.0, M51.1, M54.4). Depressive symptoms predominated in CSPD patients, who exhibited more pronounced psychopathological disturbances and two-fold higher frequency of personality disorders, comparing to those with CPS. In CSPD patients pain severity and reaction to pain syndrome were significantly higher than in CPS patients. Psychodiagnostic study revealed higher expressed anxiety and depression as well as socio-psychological maladaptation in CSPD patients as compared to CPS ones. After neurological examination, significant between-group differences were found in the frequency of muscular-tonic myofacial, syndrome and iliosacral joint dysfunction.