One of the most common anatomical sources of nonspecific back pain is sacroiliac joint (SIJ) injury. The paper gives data on the structure, features of diagnosis and treatment of pain caused by SIJ dysfunction. A multimodal approach, including psychotherapeutic techniques, kinesiotherapy, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants, is recommended for chronic pain. The authors give their own experience with drug treatment of 51 patients (36 women and 15 men; mean age, 56.4±2.1 years) with SIJ dysfunction, by using periarticular blockages with local anesthetics and glucocorticoids or radiofrequency SIJ denervation. They note the efficiency of using Airtal® as a NSAID and Mydocalm® as a muscle relaxant.

Objective : to investigate the efficiency and safety of therapeutic blockades with anesthetics and GCs, or SIJ RFD in the combination therapy of chronic low back pain due to SIJ injury. Patients and methods . The investigation enrolled 51 patients (36 women and 15 men) aged 32 to 75 years (mean age, 56.4±2.1 years). Group 1 included 32 patients (mean age, 51.75±2.65 years) who used periarticular blockades with local anesthetics and GCs; Group 2 consisted of 19 patients (mean age, 64.1±2.8 years) who underwent SIJ RFD. Results and discussion . These treatments showed high efficiency and safety. Three months after a treatment cycle, there were reductions in the intensity of pain (by an average of 47%; p<0.0001) and in the degree of disability and improvements in the physical and psychological parameters of quality of life. There were no substantial differences in the health status of patients in the two groups treated with blockades with anesthetics and GCs or SIJ RFD. Conclusion . It has been shown that the incorporation of blockades with anesthetics and GCs or SIJ RFD into the treatment of patients with chronic low back pain can improve the results of therapy.

Myofascial pain syndrome (MFPS) is a chronic pain syndrome characterized by the formation of myofascial trigger points (MTP). MFPS most frequently occurs in patients with neck pain. The peripheral and central aspects of the formation of MTP, MFPS diagnostic criteria, piriformis syndrome, fibromyalgia, the impact of MFPS on quality of life and functional activity in patients are discussed.MFPS is treated according to the international guidelines for the treatment of nonspecific spinal pain, which encompass patient education programs, therapeutic exercises, early mobilization, manual therapy techniques, and nonsteroidal anti-inflammatory drugs as first-line analgesic agents. Meloxicam is noted to be highly effective in treating low back pain, including myofascial pain.The application of a low back muscular corset and its ability to protect vertebral structures from damage are considered. At present, there is no evidence for a link between the status of spinal muscles (according to magnetic resonance imaging and computed tomography) and the intensity of pain syndrome and the degree of disability.

The paper deals with the role of a discogenic factor in the development of lumbar pain. It gives the updated CTF classification (2014) that describes disc pathological changes and the MSU classification of disc herniation. The pathogenesis and clinical manifestations of two most common manifestations of lumbar discogenic abnormalities (axial discogenic pain and disc radicle conflict), and additional methods for their diagnosis and differential (medical and surgical) treatment are discussed. Emphasis is laid on the role of inflammation in the development and maintenance of discogenic pain and in the regression of disc herniation. The paper provides the materials of the first evidence-based guideline developed by the Expert Group of the North American Spine Society (NASS) (2012) for the diagnosis and treatment of disc herniation with symptoms of radiculopathy.

In the current biopsychosocial model of back pain, there are biological (anatomic sources of pain), psychological and social components that promote its occurrence and maintenance. Nonspecific (musculoskeletal, mechanical) pain that is diagnosed, with a serious disease and radicular symptoms being ruled out, is encountered most commonly (in 85% of cases) in clinical practice. A group of patients with nonspecific back pain is very heterogeneous and needs differential treatment. The most common sources of back pain are abnormally changed discs, facet and sacroiliac joints, and muscles; however, it is often difficult to determine the main source of pain. International guidelines for the management of acute and chronic back pain have been elaborated, which assign an important role to the clarification of the benign pattern of pain to patients; their training; and recommendations for the maintenance of day-to-day activity. Medical treatment involves both nonselective and selective nonsteroidal anti-inflammatory drugs and myorelaxants as the drugs of choice. Non-drug treatments are actively used; these are manual therapy for acute pain, cognitive behavioral therapy, manual therapy, therapeutic exercises, reflex therapy, and yoga exercises for subacute and chronic pain. Whether blockades, ablations, minimally invasive neurosurgery, which are aimed at eliminating the main source of pain, is discussed if the treatment is ineffective.

Compression of the spinal nerve root, giving rise to pain and sensory and motor disorders in the area of its innervation is the most vivid manifestation of herniated intervertebral disk. Different treatment modalities, including neurosurgery, for evolving these conditions are discussed. There has been recent evidence that spontaneous regression of disk herniation can regress. The paper describes a female patient with large lateralized disc extrusion that has caused compression of the nerve root S1, leading to obvious myotonic and radicular syndrome. Magnetic resonance imaging has shown that the clinical manifestations of discogenic radiculopathy, as well myotonic syndrome and morphological changes completely regressed 8 months later. The likely mechanism is inflammation-induced resorption of a large herniated disk fragment, which agrees with the data available in the literature. A decision to perform neurosurgery for which the patient had indications was made during her first consultation. After regression of discogenic radiculopathy, there was only moderate pain caused by musculoskeletal diseases (facet syndrome, piriformis syndrome) that were successfully eliminated by minimally invasive techniques.

A medical case of a rare form of damage to the peripheral nervous system in diabetes, proximal diabetic amyotrophy (PDA), is described. PDA is characterized by asymmetric proximal lesions in the leg combined with neuropathic pain, muscle weakness and atrophy, mild sensation disorders, increased protein in the cerebrospinal fluid and severe disability. The etiopathogenesis is determined by immune-mediated lesions of vessels, nerves and nerve roots, peri-and microvasculitis, ischemia of the peripheral nervous system structures. Combination treatment with glucocorticoid medications, thioctic acid drugs (Berlithion®) normalization of glycemic profile and symptomatic treatment of neuropathic pain, resulted in a marked positive effect - decreased motor defects and pain, and significant regression of sensory disorders.

Thoracic spine pain, or thoracalgia, is one of the common reasons for seeking for medical advice. The epidemiology and semiotics of pain in the thoracic spine unlike in those in the cervical and lumbar spine have not been inadequately studied. The causes of thoracic spine pain are varied: diseases of the cardiovascular, gastrointestinal, pulmonary, and renal systems, injuries to the musculoskeletal structures of the cervical and thoracic portions, which require a thorough differential diagnosis. Facet, costotransverse, and costovertebral joint injuries and myofascial syndrome are the most common causes of musculoskeletal (nonspecific) pain in the thoracic spine. True radicular pain is rarely encountered. Traditionally, treatment for thoracalgia includes a combination of non-drug and drug therapies. The cyclooxygenase 2 inhibitor meloxicam (movalis) may be the drug of choice in the treatment of musculoskeletal pain.