An integrated approach to the treatment of vertebrogenic pain

Background. Dorsalgia is recognized as one of the global health problems. The pathogenetic basis of nonspecific back pain is the involvement of the muscular-ligamentous complex, intervertebral disc, facet joint and neural structures in the pathological degenerative process. The starting point for these processes can be considered changes that occur in chondrocytes, leading to the destruction of cartilage and a slowdown in its repair. This process is accompanied by degradation of the extracellular matrix with loss of glycosa minoglycans. Understanding the pathogenetic component of vertebrogenic pain dictates the need for an integrated approach in the treatment of this group of patients.

Objective. To evaluate the effectiveness of complex therapy for pain caused by degenerative-dystrophic changes in the spine.

Materials and methods. 30 patients with radiological signs of spondylosis and spondyloarthrosis of stage 2-3 took part in the study. All patients received complex therapy with non-steroidal anti-inflammatory drugs and an injection course of chondroprotector. The results were assessed using questionnaires and scales: VAS pain assessment and health assessment, EUROQOL-5D quality of life questionnaire, Oswestry questionnaire.

Results. Against the background of complex treatment, pronounced positive dynamics were noted in the form of regression of pain syndrome on the VAS scale from 69 (56-75) to 10 (0-15), p < 0.001 by the end of therapy. Improving the quality of life of patients according to the Osversti questionnaire (%): moderate impairments (28 ± 10) before therapy, after completion of the course minimal impairments (7 ± 5), p < 0.001. The majority of patients, 60% (n = 18), were not taking non-steroidal anti-inflammatory drugs before inclusion in the study, and already at the start of complex therapy, 28% (n = 5) were able to completely stop taking non-steroidal anti-inflammatory drugs, noting a decrease in pain and an increase in motor activity.

Conclusion. The observational study showed the positive effect of an integrated approach in the treatment of patients with exacerbation of vertebrogenic pain – a combination of non-steroidal anti-inflammatory drugs with the chondroprotector, making it possible to significantly reduce the duration of a course of non-steroidal anti-inflammatory drugs or avoid its prescription in case of moderate pain syndrome.

1. Borodulina I. V., Suponeva N. A., Badalov N. G. Nonspecific back pain: clinical and pathogenetic features and treatment options. RMJ. 2016; 25: 1699-1704. (In Russ.)

2. Maher C., Underwood M., Buchbinder R. Non-specific low back pain. Lancet. 2016; (10): 140-153.

3. Parfenov V. A., Isaykin A. I. Pain in the lumbar region. M., 2018. P. 200. (In Russ.)

4. Koes B. W., van Tulder M., Lin C. W., 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: 2075-2094.

5. Oliveira C. B., Maher C. G., Pinto R. Z., Traeger A. C., Lin C. C., Chenot J. F., van Tulder M., Koes B. W. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018; 27 (11): 2791-2803.

6. Urits I., Burshtein A., Sharma M., et al. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Current Pain and Headache Reports. 2019; 23: 23.

7. Kosinskaya N. S. Degenerative-dystrophic lesions of the osteoarticular apparatus. L.: Medgiz, 1961. P. 196. (In Russ.)

8. Helbig T., Lee C. K. The lumbar facet syndrome. Spine. 1988; 13: 61-64.

9. Turovskaya Ye. F., Filatova Ye. G., Alekseyeva L. I. Dysfunctional mechanisms of chronic pain syndrome in patients with osteoarthritis. Lecheniye zabolevaniy nervnoy sistemy. 2013; 1: 21-28. (In Russ.)

10. Pilipovich A. A., Danilov A. B. Modern approaches to the treatment of osteoarthritis. RMJ. 2014; 43. (In Russ.)

11. Bruyere O., Honvo G., Veronese N., et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019; 49 (3): 337-350.

12. Shavlovskaya O. A. The place of SYSADOA drugs in the treatment of degenerative-dystrophic joint diseases in neurological practice from the perspective of evidence-based medicine. Zhurnal nevrologii i psikhiatrii im. S. S. Korsakova. 2022; 122 (3): 38-45. (In Russ.)

13. Alekseeva L. I., Taskina E. A., Kashevarova N. G., Sharapova E. P., Anikin S. G., Strebkova E. A., Korotkova T. ., Raskina T. A., Zonova E. V., Otteva E. N. Osteoarthritis of knee joints and metabolic syndrome: new approaches to therapy. Scientific and practical rheumatology. 2018. No.2. URL: https://cyberleninka.ru/article/n/osteoartrit-kolennyh-sustavov-i-metabolicheskiysindrom-novye-podhody-k-terapii (accessed: 09/29/2023). (In Russ.)

14. Williamson A., Hoggart B. Pain: a review of three commonly used pain rating scales. Journal of Clinical Nursing. 2005; 14: 798-804.

15. Pain: a guide for students and doctors: textbook. Allowance / Pod red. akad. RAMN N. N. Yakhno. M.: MEDpressinform, 2010. P. 304. (In Russ.)

16. Rabin R., de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001; 33 (5): 337-343. DOI: 10.3109/07853890109002087. PMID: 11491192.

17. Brooks R., Boye K. S., Slaap B. EQ-5D: a plea for accurate nomenclature. J Patient Rep Outcomes. 2020; 4 (1): 52. DOI: 10.1186/s41687-020-00222-9. PMID: 32620995; PMCID: PMC7334333.

18. Fairbank J. C., Couper J., Davies J. B., et al. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980; 66: 271-273.

19. Cherepanov V. A. Russian version of the Oswestry questionnaire: cultural adaptation and validity. Khirurgiya pozvonochnika. 2009; (3): 93-98. (In Russ.)

20. Normative documentation: Pharmacopoeia article for the substance-liquid "Bioactive extract from small sea fish". (In Russ.)