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Aim: to estimate efficacy, tolerability, and safety of Ambenium® parenteral [phenylbutazone sodium 400 mg and lidocaine hydrochloride 4 mg] used for treatment of patients with low back pain. Methods. A total of 100 patients with low back pain (LBP), who received a single intramuscular injection of Ambenium® parenteral, were included in the study. The follow-up period was 3 days. The change in pain severity on VAS (mm) was selected as a primary outcome measure for efficacy. The pain syndrome severity was estimated before administration of the drug (visit 1) and 4, 6, 8 and 12 h after the drug administration, as well as during visits 2 (day 2) and 3 (day 4). The McGill Pain Questionnaire, muscle syndrome index (MSI), Roland-Morris Disability Questionnaire pain estimates were used as the secondary diagnostic criteria. The percentage of patients with the positive response relative to baseline (the decrease in pain severity on VAS by more than 50%) was also determined. Results. The dynamics of the primary efficacy measure (pain severity on VAS) was as follows: 7.4 ± 0.92 cm (mean ± standard deviation) during visit 1, 5.6 ± 1.49 cm after 2 h, 4.6 ± 1.74 cm after 4 h, 3.0 ± 1.79 cm after 8 h; the VAS score was 2.3 ± 1.70 cm after 12 h (р

Introduction: Physical activity is an inherent factor in a healthy lifestyle. Regular exercise allows you to maintain fitness with age and allows for proper functioning of everyday life. The aim of the study was to assess the impact of physical effort on the level of back pain. Materials and methods: The study involved 113 people who were assigned to one of two groups using online surveys, taking into account the level of physical activity. The occurrence of pain was assessed on the basis of the author's questionnaire and Oswestry questionnaire. Results: The subjects from group 2 do not undertake regular physical exercise and more often indicated the occurrence of spine pain. Group 1 showed a statistically significant lower risk of pain than group 2. On the basis of the Oswestry questionnaire, group 2 people are significantly more likely to be less able to perform daily activities than group 1 people. Conclusions: In people undertaking regular physical exercise, less reported pain and lower risk of their occurrence compared to group 2. The group of non-training people show less ability to perform daily activities due to pain.

Musculoskeletal neck, shoulder, upper extremity, low back pain is a disorder that is most common in office employees. Furthermore, neck pain and low back pain are the most prevalent. Neck pain and low back pain are in Top-5 of the disorders contributing to disability, ahead of other disorders, such as diabetes mellitus, chronic lung diseases, coronary artery disease. The paper considers pathogenetic features of musculoskeletal disorders developing in office employees, along with treatment options with emphasis on the neurotropic vitamins and their combinations with NSAIDs.

The article contains the data obtained during the 156-week follow-up of patients with ankylosing spondylitis (AS) in the ASTERA phase III study.Objective: to evaluate the effect impact of netakimab (NTK) on quality of life (QoL), back pain and work capacity in patients with active AS.Material and methods. The study enrolled 228 patients with active AS who were randomized 1:1 to receive NTK 120 mg or placebo. At week 52, patients in Group 1 (NTK) who achieved ASAS20 continued therapy (NTK at a dose of 120 mg once every 2 weeks) until week 156. Patients in Group 2 (placebo/NTK) received the study drug at a dose of 120 mg subcutaneously every 2 weeks from week 20 until week 68, after which the efficacy of therapy was determined (by achieving an ASAS20 response). Patients who achieved ASAS20 received treatment (NTK at a dose of 120 mg once every 2 weeks) until week 172.Results and discussion. Under NTK therapy, a significant improvement in QoL was observed in the assessment of the physical and psychological components of the SF-36 questionnaire, which was maintained during the three years of therapy: increase in indicator by 12.68±9.92; 13.27±10.14; 12.92±10.03; 14.10±10.35; 14.76±9.77 and 6.10±11.59; 5.50±11.82; 6.32±11.01; 5.87±11.45; 5.25±11.98 points at week 52, 76, 104, 128 and 156, respectively. During the extended therapy period, a reduction in the proportion of working hours missed for health reasons, an improvement in work capacity and work efficiency and an increase in daily activity were observed. Back pain (BASDAI question 2) and nocturnal back pain decreased steadily during the entire follow-up period compared to the screening values.Conclusion. NTK is an effective therapy for active AS that improves QoL scores, significantly reduces pain intensity and improves work productivity.

The aim. The significant prevalence of intervertebral discs chronic pathology in the human population against the background of the lack of a clear and unified definition of the concept of «degenerative [intervertebral] disc disease» (DDD) creates difficulties in the study and formation of treatment protocols for this pathology. This study aims to clarify the epidemiological characteristics and terminological features of the pathology of the intervertebral discs covered by the term «DDD». Materials and methods. A systematic search in pubmed and related scientific and professional databases for publications devoted to DDD’s terminological features and epidemiology was conducted. In the analysis, the papers in which DDD and semantically related concepts and clinical phenomena are included as the primary research objects. Results. Based on the analysis, it is found that there is no unified defining the concept of DDD, which includes both initial degenerative changes in the disc, regardless of the manifestation of the pain syndrome, and conditions with a clear pathomorphological picture, such as intervertebral disc herniation, degenerative spinal stenosis, etc. DDD is pathophysiological and conventional; its list of pathomorphological and clinical correlates still needs to be completed. Clinical phenomena, considered the most certain correlates of DDD, can be caused by other pathological processes. Currently, the only but somewhat inaccurate indicator of the prevalence of back pain in the human population is the epidemiological characteristic of back pain, which, according to available calculations, can reach 800 million people at any given time, i.e., 10 % of the human population. Uncertainty regarding the semantics of the term DDD makes it challenging to unify research results and develop effective clinical protocols. Conclusions. The meaning of the term DDD remains unclear and non-unified, and the epidemiological characteristics of the phenomenon of back pain can only be used with significant caution for a rough estimate of the prevalence of clinically significant forms of ddd. Unifying and clarifying terminology, prevalence, and identification of benchmark etiological factors of DDD will allow to improve treatment protocols for this pathology and improve its results.

Purpose of the study: to assess risk factors for the development of nonspecific back pain syndrome in skydivers.Materials and methods: A single-center, prospective, non-randomized study included 173 men aged 25 to 55 years who had been followed up with low back pain for 1 to 5 years. The main group included 89 people involved in parachuting (experience from 5 to 20 years, number of jumps — 276 (167; 387) times), the comparison group — 84 patients who had never jumped with a parachute. Depending on the total number of jumps, the main group was divided into 2 subgroups: less than 198 (n = 29) and more than 198 parachute jumps (n = 60). All patients underwent clinical neurological examination and magnetic resonance imaging (MRI) of the spine. MRI was used to quantify the presence of disc tissue displacements, the presence of straightening lordosis, and spondylolisthesis. Statistical processing of the obtained data was carried out using the IBM SPSS Statistics 25 program.Results: a correlation was established between the appearance of disc tissue displacement in the spine according to MRI and the number of parachute jumps in the main group (r = 0.430; p < 0.001). The indicated pathological changes in the spine in paratroopers occurred when the total number of jumps was 198 or more. Among parachutists of the main group, displacement of disc tissue in the spine correlated with the level of pain intensity (r = 0.337; p < 0.001) and the degree of functional impairment according to the results of the questionnaires Oswestry (r = 0.325; p < 0.001) and Roland Morris (r = 0.292; p < 0.001). The highest rate of pain syndrome and degree of disability was in the subgroup of paratroopers with extensive experience (p < 0.05), while other groups of patients had no differences in this indicator.Conclusions: in skydiving athletes, the intensity of pain in the lower back and the degree of degenerative-dystrophic changes depended on the number of parachute jumps.

Background. Back pain is currently one of the most urgent problems within pain syndromes. Inadequate treatment of nonspecific back pain, even with a relatively favorable prognosis, leads to its chronicity and decreases the patient's quality of life. The most common cause of vertebrogenic dorsopathies is spinal osteochondrosis. The etiopathogenetic basis of spinal osteochondrosis is degenerative and dystrophic changes in the intervertebral discs involving adjacent vertebrae, joints, and ligaments. Considering the experience of many years of using chondroprotective therapy in clinical practice, we performed an observational study using Ambene Bio to assess the change of pain severity over time in patients with osteochondrosis and back pain. Aim. To study the change in the severity of pain and its components in patients with back pain during therapy with Ambene Bio combined with standard therapy (NSAIDs and muscle relaxants). Materials and methods. Fifty-one patients with chronic lower back pain lasting more than 3 months were included in the study. Conclusion. The study results confirmed the high efficacy of Ambene Bio in patients with dorsopathies with an alternating treatment regimen (10 IM injections 2 mL every other day).

Musculoskeletal system pathology is one of the main causes of morbidity and disability worldwide. Inflammation plays the leading role in the genesis of these diseases. Pain is the most important factor leading to a critical decrease in the quality of life and limitation of daily activities. Most current international guidelines for the treatment of acute and chronic low back and neck pain, osteoarthritis, rheumatoid arthritis and other diseases recommend oral non-steroidal anti-inflammatory drugs as first-line therapy. The article presents data from the latest domestic and international studies, including the results of the largest SOS study, which demonstrated the high efficacy and safety of aceclofenac (Aertal) in acute and chronic neck and back pain.

Introduction: Sleep is a fundamental biological need of the body, crucial for maintaining health and body’s regeneration. The body position during sleep not only affects sleep quality and well-being but also influences various health aspects, such as obstructive sleep apnea, back pain or gastroesophageal reflux. Aim of the study: The aim of our study is to summarize the impact of body position during sleep on human health. We paid attention to the relationship between sleep position and aspects like: sleep quality, obstructive sleep apnea, back pain and gastroesophageal reflux. State of knowledge: The body position during sleep is crucial for maintaining mental and physical health. It affects sleep quality as well as health aspects such as: obstructive sleep apnea, back pain or gastroesophageal reflux disease. In the case of sleep quality, the most beneficial position is on the right side. The supine position is associated with worsened obstructive sleep apnea, while on the side - with reducing the frequency of symptoms. Neck pain is connected with an asymmetrical side and an upright head position, while lower back pain is associated with a supine position. The described position that reduces the reflux of gastric contents into the esophagus, and thus reduces the symptoms of reflux disease, is on the left side and with an elevated head of the bed. Summary: Sleep position is significant for many aspects of human health. Besides affecting sleep quality and well-being, it also has an impact on conditions such as obstructive sleep apnea, back pain and gastroesophageal reflux.

Objective: to study the dynamics of back pain severity and the frequency of its individual components, characterizing the inflammatory and mechanical rhythm, on the background of gestation in women with ankylosing spondylitis (AS) and compare them with manifestations of dorsopathy in healthy pregnant women; to determine the information value of BASDAI during pregnancy, i.e. to identify its components with the optimal sensitivity and specificity ratio for assessing AS activity during gestation.Patients and methods. The main group consisted of 49 pregnant women with AS who met the modified New York criteria of 1984. The average age of patients was 31.7±4.9 years, the average duration of the disease was 134.4±85.8 months. BASDAI for trimesters of pregnancy was: 2.3 [1.2; 4.4], 2.8 [1.4; 4.2] and 2.2 [1.6; 4.0]. The control group included 51 pregnant women with back pain associated with gestation, without rheumatic diseases. The average age was 28.0±4.4 years. The intensity of back pain was assessed on a numerical rating scale. ROC-analysis was performed with calculation of the area under the curve (AUC) of each component of BASDAI in each pregnancy trimester.Results and discussion. More than 80% of pregnant women with AS experienced back pain, while the intensity of general back pain did not differ from that in the control group. Night back pain with improvement on awakening in the main group was present in 70%, 58% and 68.8% of women, respectively, in the I-III trimesters; its intensity was 3 [1; 5], 3.5 [3; 6] and 3.4 [2; 5] respectively; the frequency and severity of night pain were higher than in the control group. The number of women with improvement after exercise in the II and III trimesters did not differ in both groups. In the second half of pregnancy, 40% of AS patients noted improvement during rest, 52.1% – increased pain after exercise; the frequency of mechanical rhythm pain elements remained lower than in the control group. The AUC value for BASDAI in the first trimester was 0.74; AUC of all BASDAI components was >0.5. In the II and III trimesters, the AUC values for fatigue and back pain were 0.8.Conclusion. During pregnancy the vast majority of women with AS experience back pain, the nature of which changes in the second half of gestation. Night pain that improves on awakening reflects AS activity and is not related to pregnancy. The BASDAI components of severity and duration of morning stiffness have the highest classification value during pregnancy.

Chronic low back pain (CLBP) is the most common chronic pain syndrome that causes deterioration of the quality of life and disability. Anxiety and depressive disorders are significantly more common in patients with CLBP. The negative impact of CLBP on cognitive abilities and sleep was revealed. Treatment of patients with CLBP should be started with non-pharmacological methods, including an educational program, kinesiotherapy, and cognitive behavioral therapy. Antidepressants are prescribed for CLBP to reduce the severity of associated anxiety and depressive disorders, improve sleep and relieve pain. The efficacy and safety of sertraline (Serenatа) in CLBP, its additional neurochemical mechanisms of action due to its effect on dopamine reuptake, interaction with sigma receptors, low incidence of side effects, and high adherence of patients to therapy are discussed.

The purpose of this publication is an attempt to systematize modern data based on the principles of evidence-based medicine (controlled randomized trials, systematic reviews, meta-analyses) in the field of diagnosis and treatment of non-specific low back pain. It is shown that non-specific lumbar pain is the predominant type of lumbar pain syndrome. The basis for the diagnosis of nonspecific low back pain should be a detailed history taking and a thorough physical and neurological examination. The value of imaging diagnostic methods is limited to patients with red flags. Both in the case of acute and chronic non-specific low back pain, the basis of therapy with well-proven effectiveness is patient education, manipulative techniques and special physical therapy. In the case of chronic non-specific low back pain, behavioral therapy is highly effective. Non-steroidal anti-inflammatory drugs have proven efficacy in relation to pain and functioning of the patient. In the case of chronic non-specific low back pain, muscle relaxants and antidepressants may be additionally prescribed.

Objective. To analyze dynamics of vertebrogenic pain syndrome and quality of life after transpedicular decompression in patients with depressed fractures of the thoracic and lumbar spine. Material and Methods. An observational prospective pilot study included 10 patients with AO Spine type A1 fractures of the thoracic and lumbar spine operated on in 2020–2021. All patients underwent transpedicular decompression. Severity of pain syndrome according to VAS, ODI score, and the magnitude of apical kyphosis were studied in the preoperative period and at 3 day, 1, 3, 6 and 12 month postoperative follow-up. Results. The age of patients was 35–70 years (median 46). The ratio of men and women was 1 : 4. By localization, the fractures were distributed as follows: T10 – 1 patient (10 %), T11 – 1 patient (10 %), L2 – 2 patients (20 %), T12 – 3 (30 %) and L1 – 3 patients (30 %). Statistically significant regression of pain syndrome according to VAS from 9.5 (7.3; 10.0) to 2 (1.0; 2.0) scores during the year (χ2 = 35.5, df 4, p < 0.001) was observed. Noteworthy was a rapid regression of the pain syndrome 3 days after decompression from 9.5 (7.3; 10.0) to 4.5 (4.0; 6.0) and a decrease of ODI score and improvement in the quality of life of patients from 69.0 (58.5; 82.0) to 9.0 (4.8; 10.8): χ2 = 36.8, df4, p < 0.001. During the follow-up period, an increase in the Cobb segmental angle from 5.3º°(4.1°; 6.7°) to 9.7°(8.4°; 12.5°) (p = 0.005) was observed in all patients. However, this did not affect the intensity of back pain or the quality of life of patients. Newly occurring fractures, Kümmel’s disease and postoperative complications were not identified. Instrumental diagnostics revealed spontaneous fusion at the fracture level during the first year after transpedicular decompression in all cases. Conclusion. Transpedicular decompression is an effective, safe and pathogenetically substantiated method of treating vertebrogenic pain syndrome associated with spinal fracture.

Introduction: Lumbar spine pain is a common clinical problem. Due to the multitude of causes of pain, it is important to know the most common ones in order to choose an effective method of treatment. The aim of this study: Summary of current knowledge regarding back pain caused by radiculopathy associated with lumbar stenosis. Material and method: The review includes publications published in 1995-2020. The search of the publications in the Pubmed database was carried out using the following keywords: back pain, radiculopathy, lumbar stenosis. Description of the stage of the knowledge: Lumbar radiculopathy caused by lumbar stenosis is a common clinical problem, especially in older age groups. In diagnostics, an interview with the patient, physical examination and imaging tests - especially CT and MRI - are important. In most patients, conservative treatment is sufficient - the use of analgesics and anti-inflammatory drugs and physiotherapy. In justified cases, surgical treatment should be considered as the most effective causative treatment of the disease. In the last 20 years, the availability of both diagnostic methods has increased and new surgical techniques have appeared, aiming at minimally invasive treatment. Summary: Radiculopathy caused by lumbar stenosis is a contributing factor to the occurrence of pain, which can hinder the normal functioning of the patient.Proper diagnosis, identification of the impact and methods of treatment, both conservative and surgical, can help the patient and affect his quality of life. Early diagnosis and treatment are crucial for the effective treatment of pain associated with radiculopathy caused by lumbar stenosis.

Neuropathic pain (NP) is not uncommon in clinical practice. NP can occur when various neural structures are damaged, such as peripheral nerves, spinal roots, spinal cord, and brain structures. Depending on the level of damage, NP is divided into central and peripheral. At the same time, peripheral NP is more common. When diagnosing NP, the results of a physical examination of the patient are the most valuable. In order to study the state of the peripheral neuromotor apparatus, patients undergo stimulation electromyography with an analysis of the conduction along motor fibers and sensory fibers caused by the skin sympathetic potential, and EMG using needle electrodes is often used to verify the level and stage of the pathological process. Difficulties in making a diagnosis arise when a patient has a combination of several types of neuropathic pain and comorbid pathology. For the treatment of NP, antidepressants, anticonvulsants, opioid analgesics, drugs for local anesthesia, botulinum toxin type A are used. Alpha-lipoic (thioctic) acid preparations are used in the treatment of diabetic polyneuropathy. The presence of several nosologies in a patient, each of which has individual manifestations of NP, determines the tactics of treating a particular patient, which is considered on the example of two clinical cases.

A combined approach is recommended to treat chronic non-specific low back pain (lumbago), including pharmacological and non-pharmacological methods. Kinesiotherapy and non-steroidal anti-inflammatory drugs (NSAIDs) have a high level of evidence in chronic lumbago. Kinesiotherapy includes posture and daily motor activity regimen training, a complex of therapeutic and breathing exercises, post-isometric relaxation, and other physical exercises. NSAIDs reduce pain, improve functional status, and increase patients' adherence to kinesiotherapy, relieving pain in the first days of treatment. A specific NSAID administration is usually individualized, considering the comorbidities and the risk of possible side effects. The use of meloxicam (Movalis) for back pain is discussed.

Background: Degenerative pathology of the facet joints of the lumbar spine remains a significant medical and social problem due to persistent pain syndrome, high incidence and disability rate. Clinical case description: A patient complaining of pain and discomfort in the lumbosacral spine on the right, arising in the upright position, intensifying with bending and flexion-extension of the trunk, and periodically spreading to the right gluteal region and along the posterior surface of the thigh, was admitted to the neurosurgical department of the Irkutsk Scientific Center of Surgery and Traumatology. A surgical treatment was performed in the form of dereception of the LIILIII, LIIILIV, LIVLV arch-process joints. In the postoperative period, the patient noted a decrease in the intensity of pain in the lumbosacral spine to 3 points by a visual analog scale and was discharged from the department on the 5th day after the surgery in a satisfactory condition. Conclusion: Facet joint pathologies represent a most common nosological form of the degenerative-dystrophic process (spondyloarthrosis) and a potential source of pain with the formation of instability of the spinal motion segment and chronic pain syndrome. The complex anatomical and topographic relationships between the facet joints, intervertebral discs, and radicular nerves force clinicians to pay attention to the pathology of facet syndrome. Understanding the morphological, clinical, and radiological features of the course of the facet joint degeneration makes it possible to increase the diagnostic capabilities for detecting facet syndrome of the lumbar spine and effectively apply transcutaneous surgical technologies for the treatment of chronic pain syndromes.

Back and neck pain is widespread in the population. Preferably, patients of working age are sick, which leads to serious economic losses. The transition of pain from acute to chronic increases financial costs, so effective treatment of back pain is an important medical, social and economic problem. Musculoskeletal pain (MSP) prevails among all types of back pain. The source of the MSP can be various structures of the musculoskeletal system: bones, joints, muscles, fascia, tendons, ligaments, intervertebral discs. The provoking factors for the development of the MSP are static and dynamic overloads arising from physical work, long stay in a fixed posture, unprepared movements, hypothermia, vibrations. The leading diagnostic method for the MSP is a physical research of a patient which includes a detailed collection of complaints and anamnesis, inspection in statics and dynamics, carrying out global and special tests, neuroorthopedic and neurological research. In most cases, the analysis of the results obtained allows you to set a clinical diagnosis without appointing additional research methods. Two cases of acute MSP with different localization, clinical manifestations and flow are offered to the discussion. In the first case, the process was localized in the muscles of the law back. In the second patient, the muscular tonic syndrome developed in the muscles of the neck and shoulder belt and was supported by functional blockades of the vertebral motor segments. For the treatment of both patients, NSAID, muscle relaxant, glucocorticoid, as well as non-drug therapy methods were used. For local injection therapy, a drug group of glucocorticoids was used, having a sodium phosphate and betamethazone dipropionate as part of the sodium betamethasone. The combination of two betamethazone salts provides both the rapid and prolonged effect of the drug, which makes it reasonable to use it with acute musculoskeletal pain.

Back pain and insomnia (insomnia) significantly impair the quality of life of patients. Pain contributes to the development of sleep disorders and vice versa, poor quality sleep increases pain. Sleep disorders are widespread in the population, and in chronic pain syndrome, almost 70% of patients suffer from insomnia. The National Sleep Association singles out pain as one of the leading causes of sleep disorders. The article discusses a typical clinical case of the combination and interaction of chronic pain syndrome and insomnia. A patient with acute back pain developed a sleep disorder for which therapy was not carried out. The prescribed standard therapy for back pain, which included a non-steroidal anti-inflammatory drug, muscle relaxant, made it possible to relieve pain in a short time. However, the patient’s insomnia not only persisted, but also progressed, which led to the appearance of symptoms of asthenia in the form of fatigue, irritability, decreased performance, and ultimately significantly reduced the quality of life. In order to normalize sleep, the patient was prescribed a histamine H1 receptor blocker from the ethanolamine group, namely the drug Doxylamine. Follow-up observation for 1 year showed no exacerbation of back pain and sleep disturbances. In the treatment of patients with chronic back pain, it is necessary to pay attention to the presence of sleep disturbances and provide appropriate therapy. Today, three groups of hypnotics are used in clinical practice: melatonin receptor agonists (insufficient effectiveness in acute sleep disorders), benzodiazepines (addictive and addictive), and antihistamines. The modern drug Doxylamin belongs to the group of antihistamine hypnotics, has a good efficacy and safety profile and is included in the domestic recommendations for the treatment of insomnia.

Osteoarthritis is considered a peripheral joint disease and is often ignored when discussing the prevalence and treatment of back pain. Traditionally, clinical guidelines from various countries are devoted to the treatment of nonspecific back pain (lower back pain), although this diagnosis is syndromic and is absent in ICD-10. Therefore, in real clinical practice, such diagnoses as osteochondrosis and dorsopathy simultaneously exist. The treatment strategies for back pain do not take into account chronic inflammation directly related to pro-inflammatory cytokines and oxidative stress, which makes drug therapy ineffective. It is advisable from the first days of therapy to choose parenteral forms from the group of symptomatic slow-acting drugs containing chondroitin sulfate (Chondroguard®), which will accelerate the onset of the analgesic effect and increase the effectiveness of pathogenetic therapy.

According to statistics, 70–90% of the population suffer from back pain, however, despite the enormous efforts to find ways of improving the efficacy and safety of therapy for patients with dorsalgia, and the diversity of therapeutic options, numerous challenges and issues related to the pain syndrome therapy have not been addressed. The nonsteroidal anti-inflammatory drugs (NSAIDs), having both anti-inflammatory and analgesic effects, are conventionally and most commonly used to treat back pain. However, the use of these medications is associated with the development of a rather broad range of adverse effects. The paper considers the opportunity of using the drug combination therapy with the inclusion of medications, capable of improving the NSAID efficacy and reduce the adverse reactions to NSAIDs. The results of studying the efficacy of the B vitamin combination and the combination of B vitamins with NSAID in treatment of patients with dorsalgia are reviewed.

Introduction. Radiculopathy is one of the causes of neuropathic pain. Among the causes of back pain, lumbar radiculopathy ranks second after non-specific musculoskeletal pain. Patients with radiculopathy have a marked decrease in the quality of life, a tendency to disability, which causes a large amount of diagnostic and therapeutic measures and associated economic losses. There is no unified view on the pathogenesis of radiculopathy, and the pain syndrome includes neuropathic and nociceptive components. The proposed treatment regimens for radiculopathy differ and are of a recommendatory nature.The purpose of the retrospective observational study was to study the effectiveness of the drug Neurobion® in the complex therapy of radiculopathy.Materials and methods. The study of outpatient records of 120 patients aged 25–65 years, suffering from lumbosacral radiculopathy was performed. The patients were divided into 2 groups and received basic therapy, which included NSAIDs, simple analgesics, muscle relaxants, and anticonvulsants. Patients of group 1 additionally received the drug Neurobion®.Results and discussion. Faster regression of clinical manifestations was observed in group 1 patients. The results of treatment in group 1 patients were higher both in terms of subjective feelings and objective criteria. The presence of two medicinal forms of Neurobion® allows a personalized approach to the patient’s therapyConclusions. The use of the drug Neurobion® is pathogenetically justified in the treatment of radiculopathy, provides earlier positive dynamics of subjective feelings of patients and objective indicators, improves the quality of life, leads to shorter treatment periods, reducing economic costs. The effectiveness and good tolerability of the drug Neurobion® allow us to recommend it for inclusion in the complex therapy of radiculopathy.

1240% of people with low back pain have spinal instability in degenerative-dystrophic diseases of the spine. The paper highlights the biomechanical basis for the development of segmental instability and discusses various hypotheses for the development of this condition. The authors describe the modern methods of neuroimaging used in the diagnosis of segmental instability, such as radiography, functional spondylography, CT, functional CT, MRI. Further, the paper presents provocative tests used in the diagnosis of instability: passive extension of the lumbar spine, standing, sitting, pron-instability, "scissors", compression of spinous processes, forward lean in standing position, and some others. The authors shared their experience in diagnosing segmental instability. However, the discrepancy between the data of instrumental examinations and patient complaints, poorly studied rotational and lateral instability in osteochondrosis indicate the need for a more detailed study of the instability of the spine as a whole.

Sacroiliac joint (SIJ) dysfunction is a cause of low back pain in 10–30% of cases. In 1993, the International Association for the Study of Pain (IASP) defined the following set of diagnostic criteria necessary to diagnose SIJ dysfunction: 1) the presence of pain in the areas characteristic of SIJ lesions, with special attention to pain in the Fortin area projection, with possible different types of radiation; 2) positive pain provocation tests for a SIJ lesion; 3) reduced pain after intra-articular anesthetic injection; 4) the lack of a specific nature of the lesion (fracture, inflammation, tumor, etc.). Injection of 0.5–2.5 ml of solution of an anesthetic (bupivacaine, lidocaine) and 20–40 mg of triamcinolone or 5 mg of betamethasone (1 ml) into the SIJ area is used as interventional technologies. More prolonged analgesia involves radiofrequency denervation (RFD) of the SIJ, in which needles with electrodes are placed in the projection of the nerves that innervate the SIJ, and their local thermal destruction is performed. The effectiveness of RFD of SIJ requires further investigation.

Nonspecific back pain (NBP) is one of the most common reasons to see a neurologist or therapist. Acute (12 weeks) NBPs are recognized. The diagnosis of NBP is based on anamnestic data, somatic, neurological, and neurologic-and-orthopedic examination findings and on the exclusion of the specific causes of back pain, discogenic radiculopathy, and vertebral canal stenosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are used in the pharmacotherapy of acute, subacute, and chronic NBP. Tolperisone is widely used as a muscle relaxant in Russia and in the countries of Europe and Asia. Clinical trials have shown the efficacy and good tolerance of tolperisone used alone and in combination with NSAIDs for NBP. The review presents clinical recommendations from different countries on the use of muscle relaxants in the treatment of acute and chronic NBP. It is concluded that a large-scale qualitative randomized trial should be conducted to investigate the efficacy of muscle relaxants, tolperisone in particular, in the treatment of acute, subacute, and chronic NBP.

Objective. To analyze the course of pregnancy and delivery that occurred before and after surgical correction of idiopathic scoliosis with instrumented fixation of the spine. Material and Methods. The paper presents a retrospective randomized study of 100 patients of reproductive age (18–35 years) with Lenke type 2–6 idiopathic scoliosis. The following aspects of pregnancy were analyzed: the possibility of independent conception, the pain severity according to VAS during each of the three trimesters of pregnancy, and the mode of delivery (naturally or by C-section). A comparative analysis of the data of patients operated on for the spine deformity correction before and after pregnancy and delivery was carried out. Data was collected using a questionnaire survey of patients. Detection and analysis of differences between groups were carried out using the χ2 criterion. Results. A statistical relationship was found between the presence of instrumentation installed before delivery (during or before pregnancy) and the need for C-section. It was revealed that the lower the caudal end of instrumentation within the L3–S1 region, the higher the C-section occurrence. Predominantly thoracic scoliosis (Lenke types 2–4) is characterized by higher likelihood of independent conception and lower lumbar pain intensity during pregnancy than predominantly lumbar scoliosis (Lenke types 5–6). There are also certain difficulties in conducting spinal anesthesia in patients with installed instrumentation, which negatively affects the possibility of its use. Conclusion. The issue of the course of pregnancy and delivery in idiopathic scoliosis continues to be very significant for both patients and spine surgeons who supervise them. The solution to this issue is impossible without cooperation with obstetrician gynecologists and anesthetists planning and administering anesthetic management during delivery (which is especially important in case of impossibility or significant restriction of spinal anesthesia use in such patients).

Objective. To analyze distinctions in multidisciplinary approaches with respect to the timing of patients returning to daily physical activity after uncomplicated lumbar microdisectomy and to the readiness of doctors of various specialties to work according consensus guidelines. Material and Methods. A written questionnaire survey of 60 specialists (20 neurosurgeons, 28 neurologists and 12 rehabilitologists) involved in the management of patients during the first six months after uncomplicated lumbar microdisectomy was conducted. The questionnaire included 12 questions with several answer options on the timing of returning to daily physical activity, and on the need to provide patients with written recommendations on limitations in motion regimen, physical work, sexual activity, and bracing. Results. Significant dissonance both between doctors of the same specialty and of different specialties was demonstrated in the tactics of postoperative management of patients regarding the recommended terms for returning to daily activity. All respondents found it useful to create unified written recommendations on the motion regime, 90 % of specialists are ready to use the proposed recommendations after some modification. There was a slight increase in the recommended timing for return to daily physical activity compared with the recommendations of doctors in other countries. Conclusion The demonstrated interdisciplinary differences in the treatment, rehabilitation and timing of physical activity restriction for patients after lumbar microdisectomy require unification of the tactics of postoperative management.

Back pain is one of the main global health problems with a high level of prevalence and patients’ disability. In most cases, it is associated with degenerative spine damage (degenerative disc disease), dorsopathy, discopathy (M51 and M53 according to the International Classification of Diseases, 10th revision), affecting all levels of the intervertebral disc (IVD) (cytological, chemical and biochemical) as a whole as well as biological molecules that regulate homeostasis of the disc intercellular substance (growth factors, pro-inflammatory cytokines, enzymes). A key point in IVD dehydration is that catabolic processes predominate over anabolic ones due to changed gene expression in the corresponding biologically active molecules, disc angiogenesis and neoinnervation of the structures of the fibrous ring and pulpous nucleus. The latter is responsible for chronic pain in patients.Cells supporting homeostasis in nucleus pulpous, chondrocytes, continuously synthesize and restore proteoglycans and hyaluronic acid in nucleus pulpous, restoring shock-absorbing functions of the vertebral-motor segment. Decreased activity and death of chondrocytes in the avascular disc structure is a serious problem for reparative medicine. In accordance with IVD molecular-cellular mechanisms, numerous approaches to treat degenerative disc disease are being developed, each of which, influencing one of the links in the pathogenesis, has a direct or indirect effect on IVD repair.The article describes morphology, pathogenesis and genetics of degenerative disc disease, as well as main modern strategies of biological therapy: tissue engineering, biologically active substances locally used in IVD matrix, including PRP therapy (Platelet Rich Plasma therapy), methods of gene (using the viral vector) and cell therapy, as well as experience in the local use of genetically engineered biological products. Most successful studies are a combination of cell and gene therapy with the use of synthesized matrices.

Introduction. Genetic factors can generate different variants of physiological responses to non-steroidal anti­inflammatory drugs (NSAIDs) – from the complete ineffectiveness of medicines to the appearance of adverse reactions. The presence of mutant alleles of the gene CYP2C9, which codes for a basic enzyme in the biotransformation of NSAIDs in the liver, cytochrome P4502C9, leads to reduced activity and slow metabolism of NSAIDs, increases the risk of side effects, overdose. Therefore, the study of influence of CYP2C9 gene polymorphism in our population and its influence on the effectiveness of treatment of NSAIDs in acute back pain is important. The aim of the study. To investigate the polymorphism of CYP2C9 in patients with acute back pain and its impact on the effectiveness of their treatment with the non-steroidal anti-inflammatory drugs. Materials and methods. The study involved 93 patients (60 women (64.5 %) and 33 men (35.5 per cent) aged 45 to 60 years) with acute pain syndrome and aggravation of chronic pain syndrome that were divided into two groups: 53 patients (36 women and 17 men aged 45-60 years) treated with meloxicam 15.0 mg 1 time per day and the comparative group of 40 patients (24 women and 16 men aged 45-60 years) who took celecoxib 200.0 mg/day for 10 days. Evaluation of efficiency was performed before and on the 1st, 10th day of treatment and at 30th, 90th days of observation using Visual Analogue Scale (VAS). All patients underwent a genetic test – the determination of the allelic variants CYP2C9*2 and CYP2C9*3 CYP2C9 gene with polymerase chain reaction (PCR). The data obtained were subject to statistical processing. Results. For the marker of CYP2C9(Arg144Cys) genotype Arg/Arg was found in 79.6 % of cases, genotype Arg/Cys – 20.4 % of cases, and no representative of the genotype Cys/Cys was found. For the marker of CYP2C9(Ile369Leu) genotype Ile/Ile was found in 87.1 % of cases, the genotype Ile/Leu – 12.9 % of cases and no case of genotype Leu/ Leu was found. Heterozygotes for CYP2C9(Arg144Cys) and CYP2C9(IIe369Leu) taking meloxicam demonstrated the best rate of pain reduction compared with homozygotes as on the 10-th day of treatment, and on the 90th day of observation, but the difference was not statistically significant. Heterozygotes for CYP2C9(Arg144Cys) and CYP2C9(IIe369Leu) who took celecoxib had a significantly better dynamics on the 10th day of treatment. Conclusions. The genotype frequency of the CYP2C9 (Arg144Cys) and CYP2C9 (IIe369Leu) mutant alleles in our population is about 20.0 %. One in five patients with acute low back pain has genotypes with the CYP2C9 (Arg144Cys) and CYP2C9 (IIe369Leu) mutant alleles, which means there is an increased risk of side effects of non-steroidal anti-inflammatory drug treatment. Relationship between CYP2C9 (Arg144Cys), CYP2C9 (IIe369Leu) genotypes and statistically significant better response to 10-day celecoxib treatment has been established, indicating greater efficacy of celecoxib in patients with slow metabolism of medicine, and a higher risk of side effects, especially when celecoxib is given in combination with other drugs metabolized by CYP2C9.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the main class of analgesics for the relief of acute nonspecific back pain (NSBP) and for the control of chronic one (CNSBP). The choice of a NSAID is determined by the efficacy, ease of use, and safety profile of a particular drug. Etoricoxib is one of the most successful representatives of NSAIDs, which is advisable to be used in CNSBP. Double-blind, controlled studies of patients with CNSBP have indicated that etoricoxib at a dose of 60 mg/day is significantly superior to placebo and that at a dose of 150 mg/day is not inferior to diclofenac. The important advantages of etoricoxib are its good tolerance and a relatively low risk of gastrointestinal complications. The frequency of cardiovascular and renal complications with etoricoxib is not higher than those with the most popular nonselective NSAIDs. In 2020, etoricoxib was included in the number of official indications approved by the Ministry of Health of Russia for the treatment of chronic lower back pain.

Back pain due to degenerative spine conditions is one of the most common causes for seeking medical care. Standard pharmaceutical and physiotherapy interventions are offered to manage the pain. However, those approaches can be insufficient, and interventional therapies may be used in addition to standard treatment. The main principle of the interventional therapy is administering the medication directly to the affected part of the spinal segment. The article reviews the main interventional techniques, their indications, and differences between them.

In today ‘s world, back pain is a heavy burden and leads to a decrease in the working capacity, quality of life of people. The choice of tactics of treatment of pain in a back is defined by the pain reason: nonspecific pain, the specific pain caused by serious diseases or a compression of a root. The most frequent cause of back pain is nonspecific pain due to myofascial, muscular-tonic syndrome, facet syndrome, and sacral-iliac joint dysfunction in lower back pain. The article presents clinical symptoms of these syndrome, as well as techniques of neuroorthopedic examination, which allow to detect one or more abrasions of back pain. To prevent acute non-specific pain, it is recommended to prescribe non-steroidal anti-inflammatory drugs (NSAID) and muscle relaxants. Along with pharmacological treatments, treatment of patients with back pain should be more comprehensive and include cognitive-behavioral therapy and kinesiotherapy. Determination of the source of back pain in neuroorthopedic examination makes it possible to carry out local therapy in stages using blockages with local anesthetics and glucocorticoids. In case of insufficient effectiveness of blockades, it is possible to carry out radiofrequency denervation of facet joints or sacral-iliac). Clinical and neuroorthopedic examination of a patient with back pain with identification of sources of pain, analysis of the causes that led to its development, adequate treatment and recommendations to prevent repeated exacerbations can significantly reduce the risk of chronization of back pain and improve the quality of life of patients.

Back pain (BP) is an important link in neurological pathology and one of the most common complaints in general medicine practice. The purpose of the research was: scientifically and strategically substantiate and develop a comprehensive physical rehabilitation program of persons with dorsalgia in the thoracic spine and to prove its effectiveness according to the data of the electrospondilography. Materials and methods. The study was conducted on the basis of the sports and rehabilitation club “Fifth Element” in Kyiv, 67 patients (25 men and 42 women) were taking part in our research, of the working-age with BP on the thoracic level. Results. Based on the results of previous studies, we have developed a complex physical rehabilitation program for patients with BP on the thoracic spine, which included various tools and forms of physical rehabilitation, elements of modern fitness techniques, soft tissue and connective tissue manipulative techniques, and a cognitive method -conductive therapy. Conclusion. The effectiveness of the developed program of patients with BP in the thoracic department was evaluated after the completion of the course – after 12 weeks. According to the data of ESG, the positive dynamics of indicators K1, K2, K3, К4 was observed in both the MG and CG. However, only in the MG of changes in K3 and K4 indicators were statistically significant.

Management of patients with back pain is an interdisciplinary problem requiring a package of diagnostic and differential measures. Despite the elaboration of algorithms for the differential diagnosis and therapy of back pain, a number of questions remain difficult to interpret, which can lead to diagnostic errors. This review considers the main causes of back pain and the principles of their diagnosis and treatment. It gives data from studies of therapy for nonspecific back pain with nonsteroidal anti-inflammatory drugs and muscle relaxants, aceclofenac and tolperisone in particular.

Abstract: Degenerative disease of the lumbar spine is one of the most common diseases of the human musculoskeletal system and a significant public health problem. The main manifestation of degenerative spine disease is back pain, which in most cases is treated symptomatically rather than causally. The diagnosis of degenerative spine disease has been previously based on medical history and diagnostic imaging. Recently, much attention has been devoted to the biochemical indicators of bone and cartilage metabolism, which are well understood among patients with osteoporosis. Bone turnover markers indicate the metabolic activity of bone and cartilage. They occur in blood serum, urine, and synovial fluid in the form of collagen-derived proteins or enzymes, involved in the formation or resorption of bone and cartilage tissue. The study below was aimed at assessing the usefulness of determining the markers of bone turnover and cartilage damage in the blood serum of people with degenerative disease of the lumbar spine diagnosed by MRI. The biochemical diagnostics included the measurement of inflammatory parameters. The results show that the degenerative disease of the spine is local, accompanied by inflammation, and vitamin D deficiency is among the factors leading to its development.

Inflammatory rhythm back pain and enthesitis are one of the main clinical manifestations of ankylosing spondylitis (AS), which increase in severity during pregnancy. However, addition of back pain and, possibly, enthesis in the second half of gestation, which is associated with normal pregnancy, needs to make a differential diagnosis for clarifying the genesis of pain and choosing the right management tactics, which determines the relevance of this study.Objective: to investigate the course of pain in the back, enthesis, and inguinal region, as well as the functional status in AS patients during pregnancy and to reveal clinical signs that most accurately reflect inflammatory activity during gestation.Patients and methods. A study included 36 pregnant women with a reliable diagnosis of AS according to the modified New York criteria (1984). Their mean age was 31.6±4.8 years, the mean age at the onset of AS was 21.8±10.9 years; the duration of the disease was 134.9±89.3 months. A control group comprised 30 healthy pregnant women with no history of back pain and arthritis; their mean age was 28.2±4.5 years. The pregnant women of both groups were matched for parity. They made visits at 10–11, 20–21, and 31–32 weeks of pregnancy. Pain intensity was estimated using the numerical pain rating scale (NPRS) and the functional status was assessed by the Bath Ankylosing Spondylitis Functional Index (BASFI). The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) was used to assess enthesitis.Results and discussion. During pregnancy, 94% of AS patients had back pain; its intensity by trimesters was 3 [2; 4], 4 [3; 5.5], 3 [2; 7] and was higher than in healthy pregnant women (p

Background. Insomnia is considered a risk factor for the frequency of pain, however, no reliable studies with a comprehensive analysis of the objective polysomnography data have been conducted so far. Objective. Using the method of polysomnography, to assess the changes in the structure of sleep in the chronic pain syndrome, by the example of chronic back pain. Methods. The study was carried out in two groups (basic and control,) in which the patients were examined according to the following algorithm: an objective examination, assessment of the neurological status, filling in neurological scales and questionnaires, a single comprehensive study of the night sleep (polysomnography). Results. According to the data of the polysomnographic study, presomnic disorders were detected in 25% of patients, intrasomnic disorders in 48%, and postsomnic disorders in 17%. Conclusion. These sleep patterns, measured by polysomnography, demonstrate a link between sleep disorders, changes in the psycho-vegetative status, and chronic pain syndrome.

Back pain is one of the most common causes of medical treatment and temporary disability, which makes the problem of rational therapy particularly relevant. The main means of treatment of acute nonspecific back pain (NBS) are nonsteroidal anti-inflammatory drugs (NSAIDs) and myorelaxants. A number of studies have been conducted to evaluate the efficacy and safety of NSAIDs such as dexketoprofen (Dexalgin), which is equivalent to inhibit cyclooxygenase-1 (COX-1) and COX-2, and nimesulide (Nimesil), which preferential inhibits COX-2. The clinical efficacy of dexketoprofen in NBS, osteoarthritis (OA) of different localization was shown. The scheme of administration of Dexalgin is used - intramuscular injections of 2 ml (50 mg) for 1-2 days, then oral administration of 1 tablet or sachet (25 mg) 3 times a day for 3-5 days. The efficiency of Nimesil administration in OA in patients with high risk of complications from the gastrointestinal tract (GIT) is shown. The scheme of nimesil - 1 sachet (100 mg) is used 2 times a day for no more than 15 days. Perhaps the combined appointment of Dexalgin - the first 2 days of injection, then - the transition to oral nimesil 7-10 days.

Chronic pain among the elderly aged 60 years and above is one of the «big» geriatric syndromes, and has great prognostic significance in relation to cognitive, functional and physical status.The loss of muscle strength, mass (sarcopenia) is one of the important components of chronic pain syndromes in elderly patients. Pathological findings were demonstrated by own observation of 116 patients in the geriatric unit aged 75,667.98 years (110 women, 94.8%). Most patients had a combination of several geriatric syndromes, an average of which accounted for 6.6. Among them, there were falls - 72 (62.1%), chronic pain - 85 (73.3%), senile asthenia - 51 (43.9%), etc. In most cases, chronic pain was due to osteoarthritis. According to the dynamometry data, a decrease in muscle strength was found in 45.9% of cases, without chronic pain syndrome in 9.7% of cases among patients with chronic pain syndrome. Thus, prevalence rates of decreased muscle strength were higher in patients with chronic pain, than in patients without pain. In addition, a significantly lower walking speed was found, which indicates a poor prognosis in patients of older age groups.Sarcopenia and chronic pain treatment programs for elderly patients contain a number of evidence points: therapeutic exercises, adequate intake of calories and protein, vitamin D3, reduction of the number of drugs, chondroitin sulfate (Chondrogard), glucosamine sulfate (Sustagard Artro). This program, being multicomponent, should be long and regular.

Pain syndromes in the region of the back are currently a widespread problem. According to our understanding of the pathophysiology, pain can be divided into nociceptive and neuropathic pain, but both of these components are often present in the overall picture of the pain syndrome. The prescription of effective drug complexes based on the pathogenetic dominant of the disease is the priority of the therapeutic strategy for this type of pain.

Introduction: Sciatica is a current and more common problem affecting normal functioning. Along with the development of civilization, the lifestyle has also changed, contributing to spend a large amount of time in a sitting position. Material and Methods: Review of literature data available in the Pubmed, Cochrane and Google Scholar databases. Results: Both in a standing and sitting position, the pressure exerted on the intervertebral discs increases leading to a hernia which, pressing on the roots of the L4-S1 nerves, lead to symptoms characterized by pain in the lumbar region, back of the buttock, thigh, calf, foot and paresthesia of these areas. Due to the progressive changes associated with aging, the frequency of sciatica increases with age. The basis for the diagnosis of sciatica is a carefully collected interview and examination of the patient, while imaging and neurophysiological tests can be helpful in determining the degree of compression on nerve structures. Treatment of sciatica is dependent on the cause and can be both conservative and surgical. Conclusions: Due to the increasing number of cases of sciatica, it seems necessary to expand the knowledge on the diagnostic and therapeutic possibilities of this disease.

Introduction: Back pain is one of the most common problems of the movement system. The physiotherapist's physiotherapist's long-term commitment to static body positioning and high-intensity motion, often also the height-weight divergence between the therapist and the patient, leads to the painful role of the patient. The aim of the study: Determining whether physiotherapists suffer from back pain, what the nature of those ailments are, and how their seniority affects them. Determining whether the area of ​​discomfort associated with regular sports or severe spinal injuries and the impact of sports on the intensity of pain. Material: There were 35 participants (21 women and 14 men) - physiotherapist, aged 25-63 (mean 38 years). Methodology: The survey questionnaire (questions on age, sex, height, weight, length of service, occupational specificity, spine pain, VAS scale and modified Laitinen questionnaire) were used in the study group. Results: Statistical analysis revealed the incidence of pain in the spine and their dependence on length of service, the area of the most frequently reported pain and their nature. The impact of physical activity and previous injuries to the spine on the episode in which the pain was present was not shown. Conclusions: Occupational physiotherapist is associated with chronic spinal-backbone ligament dominance, which may be related to the standing position of the work most commonly found in the study group. There was no relationship between the regular exercise of sport and the intensity of the pain experienced, as well as the dependence of the painful spine and sport or previous spinal injuries.

Sacroiliac joint (SIJ) syndrome is a relevant disorder to study because of the high prevalence of back pain conditions in people of working age. SIJ syndrome is a cause of pain in 1530% of people with chronic pain in the lower lumbar spine. This review describes the anatomical structure of the SIJ and the aetiological factors that can lead to its dysfunction. Pathogenetic links in the development of this condition are identified separately. The issue of differential diagnosis with other vertebrogenic pain syndromes is considered in detail, and diagnostic tests are presented. The main current approaches to treating SIJ syndrome are described. Interventional methods for treating SIJ dysfunction are described in detail, including radiofrequency neuroablation as an alternative to conservative management.

Chronic back pain is a significant biomedical problem due to its high prevalence and negative impact on quality of life and socioeconomic indicators. Mental disorders play a substantial role in the genesis of chronic pain. This review discusses the issues of back pain comorbid with depressive, anxiety disorders, post-traumatic stress disorder, and somatoform disorder. It also considers the features of the clinical manifestations of pain associated with mental disorders. There are data on the neurobiological relationship between pain and mental disorders and on the personality traits of patients with chronic back pain.

Among the adult population, every two persons have experienced at least an episode of back pain during their lifetime. Nonspecific (musculoskeletal) low back pain (LBP) becomes chronic in 3–10% of people. These cases require combined interdisciplinary treatment, including optimal pharmacotherapy, rational physical activity, therapeutic exercises, psychological methods, an educational program (back pain school for patients); some cases need manual therapy, massage. Psychological methods assist patients to cope with pain catastrophizing, to increase daily activity, and to reduce the likelihood of disease recurrence. The results of clinical trials and systematic reviews demonstrate that cognitive behavioral therapy and mindfulness therapy (mindfulness-based stress reduction) are effective in treating chronic LBP. The paper describes a clinical case: an example of effective treatment of a female patient with chronic nonspecific LBP, by applying an integral interdisciplinary approach.

Back pain treatment is one of the most common problems in medical practice. The paper presents the theoretical and practical bases of physical therapy for people experiencing pain in the back and neck, considers in detail the main kinesiotherapy techniques used in modern rehabilitation, analyzes the principles of their selection for the most effective recovery of locomotor activity and for reduction of the severity of pain syndrome, and discusses the modes of motor activity. Hardware techniques that facilitate the implementation of complex therapeutic movements are considered separately. A rationale is provided for the importance of increasing motor activity and muscular strength and normalizing muscle tone, by restoring blood circulation and by reducing inflammation and pathological impulses from the affected spine. The possibilities of kinesiotherapy for acute and chronic nonspecific back pain, discogenic radiculopathy, and lumbar stenosis are discussed.

Back pain (dorsopathy) is one of the common syndromes, which is specific to the whole group of diseases with similar clinical presentations. Ankylosing spondylarthritis (Bechterew’s disease) with a distinct clinical course evolving not only spinal and sacroiliac lesion, but also visceral changes is discussed using the example of a clinical case. The authors discuss Nimesulide, a drug from NSAID (non-steroidal anti-inflammatory drugs) group, in the treatment of inflammatory presentations of the disease and evaluate its efficacy.

Introduction Powerlifting consists of exercises (squat, bench press, deadlift) that are corresponding to the three popular movement patterns. Working on proper functioning of muscles involved in these movements should have a positive impact on their performance in everyday life. However, on the other hand, significant workout strain may cause overloading and lead to musculoskeletal pain. Aim To determine the impact of regular powerlifting training on the movement organ functioning. Material Study group consisting of 185 people who regularly train powerlifting. Control group consisting of 193 people who declared lack of any physical activity in terms of strength training. Methods The research was conducted with the diagnostic poll method using author’s questionnaire. Results People who train experience pain in lower spine less often. There were also significant differences in the number of people experiencing pain when walking on a flat surface, lifting items from the floor, and moving objects above the eye level between the study and the control group for the benefit of the study group. There were no statistically significant differences found between these two groups regarding joint pain or the number of people who feel pain while sitting down. Discussion People who train powerlifting are less likely to experience back pain, what suggests beneficial effect of strength training on spine functioning. Powerlifting training positively affects the quality of movement during lifting objects from the floor and moving them above the eye level, but it does not have a significant influence on the frequency of pain in peripheral joints or while sitting down.

The problem of the back pain in pregnant women is one of the most important in modern medicine. 65–90 % of pregnant women complain of the back pain. The women may have the back pain from the early stages of pregnancy, or it may occur with the growth of the fetus.The causes of the pain during pregnancy are late reproductive age, high body mass index, physical strain, pain during previous pregnancies. Vertebrogenic and pelvic pain in pregnant women can first appear at the beginning of the gestational period. According to various authors, the frequency of such pain is 30–35 %. As a rule, painful neurologic manifestations begin in the third trimester, on average at the 18 th –22 nd week of pregnancy. About a half of women with early manifestation of lumbosacral pain during the pregnancy keep suffering from pain for a year after giving birth. In 20 % of cases, symptomatic pain is felt for 3 years after the delivery. The primary factors causing the pain syndrome is the shift in the centre of gravity due to enlargement of the pregnant uterus of the postural balance. The localization of the pain depending on the peculiarities of the posture can be different. In most of cases the lower back, thoracolumbar passage, sacrum, with the occasional radiation to buttock or pelvic joint, are affected. One of the most common pain syndromes in gynecology is the myofascial syndrome characterized by hyper tonus of the muscles and fasciae and ligaments of the pelvic minor.

The article is devoted to the etiology, prevalence, differential diagnosis and selection of therapy for pain in the lumbar spine. To determine the cause of lumbar pain, coordinated actions of a neurologist and an orthopedic surgeon are necessary, since chronic pain syndrome is often caused by systemic joint damage – osteoatrosis. Using the example of a clinical case, an algorithm for managing a patient with degenerative-dystrophic changes of the lumbar spine and osteoarthrosis using nonsteroidal anti-inflammatory drugs is considered.