Chronic nonspecific low back pain (chronic lumbalgia) is one of the most common causes of disability in the adult population. Currently, effectivemethods of treatment of chronic nonspecific lumbalgia have been proposed, which include an educational program, kinesiotherapy, psychologicalmethods of treatment and optimization of drugtherapy. However, these methods are not often used in real clinical practice, which reflects the observation of a 52-year-old patient who had no positive effect from therapy for 6 months. According to the MRI data, the patient had herniated discs at the level of the lower lumbar discs, with which the patient associated a persistent pain effect. However, the examination revealed signs of damage to the facet joints and sacroiliac joint, which were of leading importance as an anatomical cause of pain. The patient also had emotional disorders, the phenomenon of catastrophization, and painful behavior. An educational conversation was held with the patient, therapeutic exercises were selected, Novema in the afternoon and Novema Night in the evening were prescribed as a non-steroidal anti-inflammatory drug. After 7 days, the pain decreased significantly, sleep improved, adherence to therapeutic gymnastics increased, after 1.5 months the pain syndrome regressed, the patient became active as before the disease. The issues of optimizing the management of patients with chronic lumbalgia and the possibility of widespread implementation of an integrated approach in clinical practice are discussed.

The treatment of patients with benign paroxysmal positional vertigo (BPPV) is an urgent issue in modern medicine.Expert Council on the diagnosis and treatment of BPPV was held in Moscow on June 1, 2024. Timely diagnosis and effective treatment play a key role in the management of patients with BPPV, reduce the risk of falls and related injuries, prevent the development of emotional disorders and impairment of daily activities. Accurate patient routing and selection of appropriate treatment can significantly reduce the duration of disability and the burden on the healthcare system. Relatively simple positional tests aimed at detecting involvement of various semicircular canals have been found to be of paramount importance in the diagnosis of BPPV. Repositioning maneuvers are of paramount importance in the treatment of patients with BPPV. They vary depending on the canal affected and aim to move the otoliths out of the semicircular canals to the vestibule of the labyrinth. If repositioning maneuvers can not be performed, effective methods of vestibular gymnastics can be used. When discussing drug therapy, it was found that the use of betahistine in addition to repositioning maneuvers or vestibular gymnastics increases the efficacy of therapy, accelerates the recovery process and prevents the development of residual non-positional vertigo.

The management of patients with cognitive impairment (CI) is one of the urgent problems of modern medicine. Vascular CI (VCI) is the second most common cause of dementia after Alzheimer's disease. The diagnosis of VCI is based on the results of a neuropsychological examination, the presence of clinical and neuroimaging signs of cerebrovascular disease, and the absence of data for other causes of CI. Socio-psychological methods, stroke prevention, correction of vascular risk factors, and stimulation of patients to regular physical and mental activity are of leading importance in the management of patients with VCI. The effectiveness and safety of citicoline in VCI are discussed.

OBJECTIVE:To determine the prevalence of insomnia and the effectiveness of its treatment in patients with a painful form of diabetic polyneuropathy (DPN). MATERIAL AND METHODS:Fifty patients with the painful form of DPN were randomly divided into 2 groups: the standard therapy group (ST) and the extended therapy group (ET). In the ST group, a single lesson on sleep hygiene was conducted, in the ET group there were 3-4 face-to-face individual sessions for the treatment of insomnia for two weeks. Both groups were interviewed at the time of hospitalization, after 3 and 6 months. The severity of polyneuropathy and the nature of neuropathic pain were assessed using the Neuropathic Neuropathy Impairment Score in the Lower Limbs (NIS-LL) and the Neuropathy Total Symptom Score - 9 (NTSS-9); the intensity of pain was assessed using a Visual Analog Scale (VAS). Sleep disorders were analyzed using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). RESULTS:Sleep disorders of varying severity were observed in 82% of patients in the initial survey. In both groups, improvement in sleep quality was noted during treatment, but significantly better results were in the ET group, the ISI score after 6 months was 7.15±2.08 for the ST group and 3.07±2.49 for the ET group (p<0.0001). In the ST group, there was no significant decrease in the intensity of pain and the severity of polyneuropathy in dynamics. In the ET group, a significant decrease in NTSS-9 and VAS scores was found during the initial survey and after 6 months (p<0.0001). The intensity of pain also significantly decreased in the ET group compared with the ST group (p<0.0001) at the end of follow-up, which indicates the importance of sleep normalization in the treatment of neuropathic pain. CONCLUSION:Most patients with the painful form of DPN have insomnia. Treatment of insomnia has shown its effectiveness as part of a multimodal approach to the managing of neuropathic pain in DPN and improving the quality of life of patients.

Diagnostic hypothesis of Alzheimer's disease (AD) is based on the typical clinical picture of the disease and the exclusion of other diseases manifesting by cognitive and behavioural disorders by MRI scans of the brain and laboratory tests. For an accurate diagnosis of AD and exclusion of other diseases, detection of biological markers (biomarkers) of AD in the cerebrospinal fluid (CSF) is of great importance: a decrease in the level of beta-amyloid (Ав^ -42) and an increase in the level of phosphorylated tau protein. The analysis of AD biomarkers in the CSF of 63 patients (16 men and 47 women, mean age 72±8.7 years) with a typical picture of AD [30 patients in the moderate cognitive impairment (MCI) stage and 33 in the mild dementia stage] allowed us to confirm the diagnosis in 54 cases (85.3%) and to exclude it in the remaining nine patients (14.7%). We present a case of a 59-year-old patient with MCI in whom biomarkers typical of AD were detected in the CSF, confirming the diagnosis of AD. We also present the observations of two patients with possible AD, in whom the results of the CSF examination made it possible to rule out AD and indicated hippocampal sclerosis and tauopathy. At present, an accurate diagnosis of AD based on the study of biomarkers of the disease is of great practical importance, since at the stage of MCI and mild dementia it is possible to prevent the progression of AD with anti-amyloid therapy. Currently, AD is rarely diagnosed in our country, so it is of great importance to inform physicians about modern methods of diagnosis and treatment of AD.

Migraine is a chronic neurological disorder that is associated with considerable disadaptive effect on patients. Despite the development of pharmacotherapy strategies for migraine, only one third of patients are satisfied with their overall treatment. Many migraine patients turn to complementary and alternative medicine (CAM), which is not usually considered a part of conventional medicine and is not always evidence-based. In practise, however, they are often used to improve the effectiveness of standard therapy or to provide alternative treatment. In addition, in CAM methods, the patient is actively involved in the choice of treatment strategies, and they have good adherence. The basic principles and approaches of CAM are increasingly being introduced into clinical practise. This review discusses the principles of CAM in the treatment of migraine as a holistic approach using lifestyle strategies and selected non-pharmacological treatments that have been shown to be effective and rational.

Treatment of acute non-specific back pain (ANSBP) is one of the current issues of modern medicine, as ANSBP is one of the most common causes of temporary disability in the population. Non-steroidal anti-inflammatory drugs (NSAIDs) are used in ANSBP , with the drug Nalgesin® forte (naproxen 550 mg) being widely used in clinical practice. Objective : to evaluate the efficacy and safety of the drug Nalgesin® forte in patients with ANSBP. Material and methods . The observational study “Nalgesin® forte (naproxen) in real-life clinical practice: treatment outcomes in patients with acute non-specific (musculoskeletal) pain” included 12,434 patients (46.51% men, 53.49% women; mean age of patients – 47.3±13.8 years) with ANSBP. Pain in the lumbar region and in the neck prevailed (lumbodynia – 25.5%, lumboischialgia – 26.28%, cervicalgia – 33.03%), less frequently the pain was localized in the thoracic region (thoracalgia – 15.18%). We assessed pain intensity using numeric rating scale (NRS), indicators of the Russian version of the Kiel questionnaire, duration of therapy with Nalgesin® forte, satisfaction with the therapy and tolerability of the treatment. The patients were informed about the benign nature of the ANSBP and took the medication Nalgesin® forte 550 mg 1–3 times a day for pain relief; the medication was discontinued when the pain resolved or decreased significantly. Results . The majority (75.9%) of patients received Nalgesin® forte at a dose of 550 mg twice daily, 14.3% – 550 mg once daily and 9.8% – 550 mg three times daily. The duration of therapy was 6–14 days in the majority (80.03%) of patients, while it did not exceed 1 week in more than one third of patients (37.2%). During treatment, the average pain intensity decreased from 6.6±1.60 to 1.82±1.32 points according to the NRS (p<0.001), the proportion of patients with initially unbearable pain decreased from 2.79 to 0.28%, with severe pain – from 27.16 to 1.10%, with moderate pain – from 60.42 to 2.82%, and the proportion of patients with mild pain increased from 9.63 to 95.8% (p<0.001). Most physicians (91.7%) were satisfied with the treatment results, and most patients (94.5%) and physicians (95.7%) were satisfied with the tolerability of the treatment. Patients with a high and medium risk of chronic pain according to the Kiel questionnaire required longer treatment than patients with a low risk of chronic pain (p=0.002). A low incidence of adverse events (AEs) was observed when taking Nalgesin® forte; no serious AEs were recorded. Conclusion . Favourable therapeutic outcomes in ANSBP, efficacy and safety of the drug Nalgesin® forte in ANSBP of different localisations were noted.

The literature review presents approaches to the management of patients with vestibular disorders. The principles of organization of vestibular rehabilitation in peripheral vestibular hypofunction, indications for appointment, factors influencing its implementation, technique, methods of evaluating effectiveness are considered in detail. Attention is drawn to the fact that the selection of exercises and the duration of vestibular rehabilitation is carried out individually and depends on many factors, including the nature of vestibular deficiency and the specific characteristics of the patient. The possibilities of using additional pharmacological therapy with histamine preparations, which can accelerate the onset of vestibular compensation, are shown. It is noted that vestibular rehabilitation is a safe and effective method of treating peripheral vestibular hypofunction and should be recommended to patients of all ages with vestibular disorders leading to limited social and physical activity.

OBJECTIVE:To conduct a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of Prospekta in the treatment of SCI of varying severity. MATERIAL AND METHODS:The meta-analysis included the results of RCTs of the efficacy of Prospekta in the treatment of VCI, the severity of which was assessed using the Montreal Cognitive Scale (MoCA). The pooled effect estimate included all publications of double-blind, placebo-controlled RCTs that provided sufficient MoCA efficacy data to support further statistical analysis. The main result of the meta-analysis was obtained for the final values of the efficacy indicator in the groups of patients receiving the drug Prospekta, in comparison with the placebo group. RESULTS:A meta-analysis of the effectiveness of Prospekta in the treatment of SCI of varying severity was carried out based on data from 3 RCTs and 2 CTs involving 12.701 patients aged 18 years and older. When using the mixed models method, the effect size for the endpoint «change in total MoCA score from baseline to follow-up visit» was 3.4 points for Prospekta (2.7 points for placebo, p<0.0001); for the end point «∆ between changes in the total score on the MoCA scale while taking Prospekta and placebo» - 0.6736 points (p<0.0001). CONCLUSION:A statistically significant improvement in cognitive function according to the MoCA scale was demonstrated in patients with VCI using the drug Prospekta.

Narrowing of the central spinal canal in the lumbar spine (central lumbar stenosis, CLS) is one of the most common causes of lumbar pain, disability and spinal surgery in the elderly. The most common is acquired degenerative CLS, in which the main role play lumen-narrowing medial intervertebral disc herniating with ossification phenomena and marginal bone proliferation on the sides of the vertebral bodies – osteophytes, hypertrophy of the facet joints with their medial displacement, hypertrophy of the yellow ligament. The development of CLS can also be a consequence of spondylolisthesis, postoperative changes, rheumatic diseases and other causes. Both the compression of the cauda equine roots due to narrowing of the spinal canal and their ischemia, caused by compression of the radicular vessels and venous congestion play an important role in the pathogenesis of CLS. CLS develops in elderly age and occurs predominantly in men. The main clinical manifestation of CLS is neurogenic (caudogenic) intermittent claudication, which manifests as pain, numbness and weakness in the legs when the patient walks or stands for a long time but subsides when the patient sits or stands and bends forwards (flexion in the lumbar spine). The diagnosis of CLS is confirmed by magnetic resonance imaging (MRI), which shows a narrowing of the spinal canal and makes it possible to rule out specific causes of lumbar pain. It is important to note that, according to MRI, CLS often occurs at an older age, so its detection in the absence of clinical manifestations does not require an immediate discussion of the prospects of surgical treatment. Pain in patients with CLS according to MRI may be musculoskeletal in nature. Therefore, the diagnosis of CLS should include specific clinical manifestations and stenosis on MRI. In patients without clinical manifestations of CLS, osteoporosis and severe concomitant somatic diseases, only conservative therapy is recommended. Modern conservative treatment of CLS includes an educational program, therapeutic exercises (kinesiotherapy), psychological therapy methods for emotional disorders (cognitive-behavioral therapy), manual therapy and pharmacotherapy. Complex conservative treatment of CLS can reduce pain, improve the patient's condition and in some cases increase the patient's walking distance.

Alzheimer's disease (AD) is the most common degenerative disease of the brain leading to dementia. AD is the most common cause of disability among age-related diseases. The diagnosis of AD is based on clinical findings and is confirmed by the presence of positive biological markers of the disease, which reflect the pathological formation of beta-amyloid and tau protein in the brain. Magnetic resonance imaging of the brain shows brain atrophy in AD and helps to rule out other diseases. Psychosocial and behavioral approaches form the basis for the treatment of patients with AD; cognitive training in combination with regular physical exercise is recommended. Acetylcholinesterase inhibitors and the glutamate receptor blocker memantine are used as drugs that improve the cognitive functions of patients with AD. Dispersible forms of memantine are used to treat dysphagia in patients with AD. The efficacy and safety of pathogenetic therapy aimed at eliminating cerebral beta-amyloid by passive immunization is under discussion. Unfortunately, AD is rarely diagnosed in our country; doctors are not sufficiently informed about the diagnosis and modern treatment methods of AD. Many AD patients are observed with the misdiagnosis of chronic cerebrovascular disease and do not receive effective therapy. A clinical observation of a patient with early-onset AD is presented, reflecting typical errors in patient management. Issues for optimizing the management of AD patients are discussed.

Objective: to evaluate the effect of kinesiotherapy on the intensity of neuropathic pain, physical activity and emotional state of patients with diabetic polyneuropathy (DPN). Material and methods. The study included 65 patients with a painful form of DPN who were randomly divided into two groups: the standard therapy (ST) group and the extended therapy (ET) group, in which three to four additional face-to-face sessions were conducted to create a 15-minute individualized exercise program. The type of neuropathic pain was assessed using the Neuropathy Total Symptom Score – 9 (NTSS-9). Pain intensity was assessed using a visual analogue scale (VAS), patients' emotional state was assessed using the Beck Depression Scale and the Spielberger Anxiety Scale (with an assessment of personal anxiety). The examination was carried out at baseline, and after 3 and 6 months. At baseline, patients in the ST and ET groups did not differ (p ≥ 0.05) in parameters such as pain intensity according to VAS (6.65 ± 1.93 and 6.07 ± 1.91 points respectively), neuropathic pain according to NTSS-9 (13.65 ± 4.54 and 11.79 ± 5.09 points respectively), physical activity according to IPAQ-SF (20.1 ± 10.0 and 18.8 ± 9.1 points), personal anxiety according to Spielberger scale (51.00 ± 6.10 and 47.33 ± 9.73 points), depression according to Beck scale (15.75 ± 7.77 and 14.67 ± 8.73 points). Results. After treatment, there was a more significant reduction in pain intensity according to VAS in the ET group than in the ST group – to 3.67 ± 2.55 and 6.10 ± 1.41 points respectively after 3 months (p < 0.05) and to 2.60 ± 1.45 and 5.80 ± 1.06 points respectively after 6 months (p < 0.001), reduction in neuropathic pain according to NTSS-9 scale to 4.88 ± 4.39 and 13.13 ± 2.96 points after 3 months (p < 0.001) and to 3.55 ± 2.52 and 13.08 ± 3.86 points after 6 months (p < 0.001), a decrease on the personal Spielberger Anxiety Scale to 42.33 ± 7.66 and 51.30 ± 7.22 points after 6 months (p = 0.01), a decrease on the Beck Depression Scale to 10.07 ± 9.31 and 16.70 ± 4.34 after 6 months (p < 0.05). Conclusion. Kinesiotherapy in complex therapy of DPN leads to a reduction in pain and an improvement in functional and emotional state of patients.

Among functional neurological disorders functional dystonia (FD) is the most difficult to diagnose. We present an observation of a 44-year-old patient, who was observed for a long time with a diagnosis of cervical dystonia (CD) and received disability for this disease. The patient did not have typical manifestations of CD — repetitive stereotypical movements or postures of the head/neck, sensory trick, tonic tension of the neck muscles. For a long time, the patient experienced pain of various localizations and other manifestations of FNR. The psychiatrist regarded the condition as symptoms of a schizotypal disorder. An educational program, therapeutic exercises, and botulinum toxin management led to a decrease in the manifestations of FD. The issues of pathogenesis, diagnosis, differential diagnosis and treatment of FD are discussed.

Treatment of patients with chronic non-specific back pain (CNBP) is an important issue not only in medicine, but also in modern society as a whole, as it is associated with significant socio-economic burden.The lecture presents the most common anatomical sources of CNBP, the causes of CNBP and issues of differential diagnosis. Much attention is paid to the basic principles of therapy for CNBP: drug therapy, kinesiotherapy and psychological methods. Clinical observations are presented that demonstrate the effectiveness of a multimodal integrated approach to the treatment of CNBP based on the use of cognitive behavioral therapy, educational programs and kinesiotherapy and self-monitoring test tasks.

The purpose of this study was to investigate the antimicrobial activity of citrate-stabilized sols of cerium oxide nanoparticles at different concentrations via different microbiological methods and to compare the effect with the peroxidase activity of nanoceria for the subsequent development of a regeneration-stimulating medical and/or veterinary wound-healing product providing new types of antimicrobial action. The object of this study was cerium oxide nanoparticles synthesized from aqueous solutions of cerium (III) nitrate hexahydrate and citric acid (the size of the nanoparticles was 3–5 nm, and their aggregates were 60–130 nm). Nanoceria oxide sols with a wide range of concentrations (10−1–10−6 M) as well as powder (the dry substance) were used. Both bacterial and fungal strains (Bacillus subtilis, Bacillus cereus, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Proteus vulgaris, Candida albicans, Aspergillus brasielensis) were used for the microbiological studies. The antimicrobial activity of nanoceria was investigated across a wide range of concentrations using three methods sequentially; the antimicrobial activity was studied by examining diffusion into agar, the serial dilution method was used to detect the minimum inhibitory and bactericidal concentrations, and, finally, gas chromatography with mass-selective detection was performed to study the inhibition of E. coli’s growth. To study the redox activity of different concentrations of nanocerium, we studied the intensity of chemiluminescence in the oxidation reaction of luminol in the presence of hydrogen peroxide. As a result of this study’s use of the agar diffusion and serial dilution methods followed by sowing, no significant evidence of antimicrobial activity was found. At the same time, in the current study of antimicrobial activity against E. coli strains using gas chromatography with mass spectrometry, the ability of nanoceria to significantly inhibit the growth and reproduction of microorganisms after 24 h and, in particular, after 48 h of incubation at a wide range of concentrations, 10−2–10−5 M (48–95% reduction in the number of microbes with a significant dose-dependent effect) was determined as the optimum concentration. A reliable redox activity of nanoceria coated with citrate was established, increasing in proportion to the concentration, confirming the oxidative mechanism of the action of nanoceria. Thus, nanoceria have a dose-dependent bacteriostatic effect, which is most pronounced at concentrations of 10−2–10−3 M. Unlike the effects of classical antiseptics, the effect was manifested from 2 days and increased during the observation. To study the antimicrobial activity of nanomaterials, it is advisable not to use classical qualitative and semi-quantitative methods; rather, the employment of more accurate quantitative methods is advised, in particular, gas chromatography–mass spectrometry, during several days of incubation.

Chronic cerebrovascular diseases (CVD) and neurodegenerative diseases (NDD) are the most common causes of cognitive impairment (CI). The development of dementia is preceded by mild CI (MCI) over several years.Objective: to investigat the effect of inhaled nitric oxide therapy on cognitive function (CF) in patients with MCI due to CVD and NDD.Material and methods. The study included 94 patients (25 men and 69 women aged 50 to 76 years, mean age 65.3±8.9 years) with MCI due to CVD and/or NDD of the brain. The patients were randomized into two groups: the main group (therapy) and the control group. The control group comprised 22 patients with MCI (5 men and 17 women aged 50 to 76 years, mean age 62.3±8.5 years) who received standard therapy (antihypertensive, antithrombotic and other agents). The main group comprised 72 patients (20 men and 52 women aged 50 to 76 years, mean age 66.2±8.0 years) who additionally inhaled a nitric oxide-enriched air mixture for 30 minutes daily using the Tianox device. Each patient had from 7 to 10 inhalation sessions (the first trial session lasted 20 minutes, the following sessions 30 minutes). Neuropsychological tests, emotional state and sleep quality were examined at the beginning and 3 and 6 months after the end of treatment. Results. In the main group, after 3 and 6 months, a significant (p<0.05) improvement in CF was found according the Montreal Cognitive Assessment (MoCA-test), Frontal Assessment Battery, the Digit Forward and Backward Span Test, the Digit Symbol Substitution Test, the Munsterberg Test, the Literal Association Test and the 12-word Delayed Free Recall Test. A significant (p<0.05) decrease in anxiety and depression according to the Hospital Anxiety and Depression Scale, the Beck Depression Inventory and the Spielberger Anxiety Scale as well as an improvement in sleep quality according to the Insomnia Severity Index were also observed. The therapy was well tolerated, and no serious adverse events occurred. No significant improvement in CF, emotional state or sleep was observed in the control group.Conclusion. Brief therapy (7–10 sessions) with inhaled nitric oxide improves the CF and emotional state of patients with MCI on a background of CVD and NDD. Further studies on inhaled nitric oxide therapy in patients with MCI in a multicenter randomized trial with sham treatment are needed.

Alzheimer's disease (AD) is the most common degenerative disease of the brain leading to dementia. AD is the most common cause of disability among age-related diseases. The diagnosis of AD is based on clinical findings and is confirmed by the presence of positive biological markers of the disease, which reflect the pathological formation of beta-amyloid and tau protein in the brain. Magnetic resonance imaging of the brain shows brain atrophy in AD and helps to rule out other diseases. Psychosocial and behavioral approaches form the basis for the treatment of patients with AD; cognitive training in combination with regular physical exercise is recommended. Acetylcholinesterase inhibitors and the glutamate receptor blocker memantine are used as drugs that improve the cognitive functions of patients with AD. Dispersible forms of memantine are used to treat dysphagia in patients with AD. The efficacy and safety of pathogenetic therapy aimed at eliminating cerebral beta-amyloid by passive immunization is under discussion. Unfortunately, AD is rarely diagnosed in our country; doctors are not sufficiently informed about the diagnosis and modern treatment methods of AD. Many AD patients are observed with the misdiagnosis of chronic cerebrovascular disease and do not receive effective therapy. A clinical observation of a patient with early-onset AD is presented, reflecting typical errors in patient management. Issues for optimizing the management of AD patients are discussed.

Experts discussed the problem of comprehensive medical treatment of vertigo through vestibular rehabilitation. Peripheral vestibular vertigo is most commonly caused by benign paroxysmal positional vertigo, Meniere's disease and vestibular neuronitis, while central vestibular vertigo is caused by vestibular migraine and stroke. Vestibular rehabilitation is one of the most effective areas of treatment for patients with various disorders of the vestibular system characterized by chronic dizziness. Vestibular rehabilitation improves patients' walking and stability and can lead to an improvement in patients' daily activities and quality of life. Currently, in our country medical rehabilitation centres are being established where patients with various causes of vestibular vertigo can receive complex therapy, including vestibular rehabilitation. The Expert Council recommends the comprehensive personalised use of vestibular rehabilitation in the complex treatment of various diseases manifested by dizziness. An educational program is needed for neurologists, ENT specialists and rehabilitation specialists in treatment of patients with different types of vestibular dizziness.

In recent decades, there has been an increase in the prevalence and medical and social burden of osteoarthritis (OA) and nonspecific back pain in all countries of the world. The First Multidisciplinary Bilateral Russia-Uzbekistan Expert Council presented innovations in the prognosing, personalized prevention and adjuvant therapy of degenerative-dystrophic diseases of the joints and spine, the evidence base for the effectiveness and safety of the use of drugs that modify the course of OA (Disease-modifying osteoarthritis drugs, DMOADs): chondroitin sulfate, glucosamine sulfate, undenatured type II collagen for adjuvant pharmaconutraceutical support – prevention and adjuvant therapy (treatment) of OA and nonspecific lumbosacral pain. The expert counsil resolution presents an optimized algorithm for the management, prevention and adjuvant therapy of OA and non-specific back pain, maintaining the function of healthy joints after intense physical activity with the inclusion of the drug Chondroguard solution for intra-articular and intramuscular administration (INN – chondroitin sulfate) and a new pharmaconutraceutical from the DMOADs group – TRIO trademark Chondroguard® (Chondroguard®TRIO).