Back pain in therapeutic practice

Back pain is an interdisciplinary medical problem, but, nevertheless, the primary appeal of these patients is to therapists and general practitioners, who are responsible for timely differential diagnosis and prescribing a full range of therapy in cases where back pain is not a manifestation of serious or life-threatening illness. In the vast majority of cases, back pain is non-specific, i.e., its development is not associated with a life-threatening systemic disease or injury. The term «non-specific back pain» means that it was not possible to identify a serious pathology (disease) that caused the pain. In addition, there should be no specific signs of involvement in the process of the roots of the spinal nerves and stenosis of the spinal canal. The most urgent tasks in the work of a therapist or general practitioner are the correct differentiation of the causes of back pain, the identification of «red flags» and the referral of the patient for treatment to a specialist in case of establishing specific causes of pain. The article considers the standard of examination with the participation of therapists, general practitioners, offers a specially developed algorithm for managing patients with back pain. The formation of the skills of curation of patients with back pain by primary outpatient physicians is necessary for the appointment of a full-fledged complex of therapy in case of its non-specific nature and timely referral to a specialist in case of specific reasons for its detection. The general principles of the treatment of back pain include informing the patient about the main causes of back pain, the role of an active lifestyle and dosed physical activity, avoiding prolonged bed rest. The general therapy of back pain syndrome involves the use of agents that affect the pathogenetic underlying mechanisms: inflammation, painful muscle hypertonicity, impaired trophism of the nervous tissue, etc. The ineffectiveness of non-drug therapy is an indication for the appointment of non-steroidal anti-inflammatory drugs, primarily for external use in the form of ointments, creams or gel and / or their systemic use, as well as symptomatic slow-acting drugs for osteoarthritis (SYSADOA).

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