Медицинский совет (Sep 2021)
Low back pain: a case study
Abstract
As defined in the WHO Bulletin (1999), low back pain (LBP) is pain, muscle tension or stiffness localized in the back between the XII pair of ribs and the lower gluteal folds, with or without irradiation in lower limbs. The LBP syndrome is not a nosological unit, but due to its high prevalence, social and economic importance, it has a separate heading in ICD-10 – (M 54.5). Various structures can be the source of LBP: intervertebral discs, facet and sacroiliac joints, muscles, ligaments, tendons, fascia, spinal cord and its roots, peripheral nerves, etc. Depending on which structure the source of pain is, the nature of the pain can have a nociceptive, neuropathic or mixed character, which affects the tactics of patient management. The variety of clinical manifestations of LBP introduces certain difficulties in the process of making a diagnosis and may entail the appointment of treatment methods that are inadequate for the patient’s condition. In such cases, it is advisable to conduct an additional consultation in order to obtain a second medical opinion. The message is devoted to the analysis of a clinical case of LBP. During the examination of the patient, the nature of the pain, initially regarded as neuropathic, began to be interpreted as nociceptive. In accordance with this, a complex treatment was prescribed, which included pharmacological preparations and methods of non-drug therapy. In order to quickly relieve the pain syndrome, the drug dexketoprofen was used according to a stepwise scheme. Obtaining effective anesthesia within 5 days made it possible to abandon further NSAID intake and to continue follow-up treatment with a preparation of B vitamins, a muscle relaxant and SYSADOA in combination with non-drug methods of treatment. The considered clinical case illustrates both the difficulties arising in the diagnosis of LBP and the possibilities of successful conservative therapy of this disease.
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