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Diagnostic hypothesis of Alzheimer's disease (AD) is based on the typical clinical picture of the disease and the exclusion of other diseases manifesting by cognitive and behavioural disorders by MRI scans of the brain and laboratory tests. For an accurate diagnosis of AD and exclusion of other diseases, detection of biological markers (biomarkers) of AD in the cerebrospinal fluid (CSF) is of great importance: a decrease in the level of beta-amyloid (Ав^ -42) and an increase in the level of phosphorylated tau protein. The analysis of AD biomarkers in the CSF of 63 patients (16 men and 47 women, mean age 72±8.7 years) with a typical picture of AD [30 patients in the moderate cognitive impairment (MCI) stage and 33 in the mild dementia stage] allowed us to confirm the diagnosis in 54 cases (85.3%) and to exclude it in the remaining nine patients (14.7%). We present a case of a 59-year-old patient with MCI in whom biomarkers typical of AD were detected in the CSF, confirming the diagnosis of AD. We also present the observations of two patients with possible AD, in whom the results of the CSF examination made it possible to rule out AD and indicated hippocampal sclerosis and tauopathy. At present, an accurate diagnosis of AD based on the study of biomarkers of the disease is of great practical importance, since at the stage of MCI and mild dementia it is possible to prevent the progression of AD with anti-amyloid therapy. Currently, AD is rarely diagnosed in our country, so it is of great importance to inform physicians about modern methods of diagnosis and treatment of AD.

Objective: non-interventional study ELBRUS (Etoricoxib in the Treatment of Back Pain) was conducted to investigate the efficacy and safety of daily administration of Rixia® (Etoricoxib) 60 mg per day in patients with chronic non-specific low back pain (CNSLBP).Patients and methods. The study included 50 patients (31 women and 19 men, mean age 54.3±16.8 years) with CNSLBP. Educational conversation, cognitive therapy, regular therapeutic exercises, identification and treatment of comorbidities were conducted. Patients received etoricoxib 60 mg once daily. Pain intensity was assessed on a 10-point numerical rating scale (NRS), pain-related disability was assessed on the Oswestry Scale (ODS), and emotional state was assessed on the Hospital Anxiety and Depression Scale (HADS).Results and discussion. The causes of CNSLBP were: in 5 (10%) patients – sacroiliac joint involvement, in 14 (28%) – lower lumbar facet joints involvement, in 3 (6%) – myofascial pain, the remaining 28 (56%) patients had a combination of several reasons. As a result of complex treatment, the intensity of pain at rest decreased on average from 4.0±2.5 to 1.4±1.3 points, while moving – from 6.6±1.9 to 2.8±1.8 points, at night – from 2.7±2 to 0.7±0.9 points according to the NRS, disability – from 39±18.9 to 19.9±14.6% according to the ODS, the severity of anxiety – from 6.5±3.9 to 3.3±2.4 points and depression from 5.0±3.7 to 3.1±2.9 points according to HADS (p˂0.001). The duration of treatment was 14.14±3.6 days on average. No adverse events were observed during treatment with etoricoxib.Conclusion. The efficacy and safety of etoricoxib in the complex therapy of patients with CNSLBP was noted.

Objective: to elucidate the frequency and pathogenesis of myofascial pain syndrome (MFPS) in chronic nonspecific lower back pain (CNLBP) and to optimize the diagnosis and treatment of MFPS in CNLBP.Patients and methods. The investigation covered 121 patients with CNLBP. The patients' mean age was 42.1±10.5 years; the pain duration was 7.9±4.3 months. The possible causes of CNLBP were determined: these were facet joints (FJs); sacroiliac joints (SIJs); skeletal muscles with the development of MFPS; MFPS concurrent with FJs; MFPS concurrent with SIJs. Twenty patients had MFPS only (its mean duration was 5.3±2.2 months; the mean pain intensity scores were 6.5±1.1 on a numerical rating scale). Six patients underwent examinations of open biopsy specimens of the muscle straightening the spinal column; a comparison group consisted of 3 healthy women matched for age and gender. The patients were prescribed therapy with aceclofenac 200 mg/day in combination with tolperisone 450 mg/day and nondrug therapy (cognitive behavioral therapy and kinesio- and ergotherapy). When the treatment was insufficiently effective, ultrasonography of the muscle straightening the spinal column was additionally performed; a local anesthetic was injected into myofascial trigger points (MTPs).Results and discussion. MFPS was a cause of pain syndrome in 63 (52%) patients, while MFPS this was an isolated cause of pain in 20 (16.5%) cases and was concurrent with FJ osteoarthritis in 23 (19%), and with SIJ dysfunction in 20 (16.5%). Muscle ultrasonography in patients with MFPS revealed MTPs, whereas examinations of biopsy specimens of the muscle straightening the spinal column showed no evidence of necrosis, fibrosis, or inflammatory infiltration in the presence of transformation of the myosin phenotype, by increasing the proportion of rapidly fatigued type II muscle fibers. The results of sodium dodecyl sulfate (SDS) gel electrophoresis indicated a decrease in the content of titin and nebulin, the sarcomeric cytoskeletal proteins involved in maintaining muscle contractility. A two-week cycle of therapy with aceclofenac and tolperisone reversed pain syndrome in 5 (25%) of the 20 patients and reduced the intensity of back pain in 15 (75%), but the pain increased during physical exercise and impeded active rehabilitation. The additional administration of anesthetics into MTPs and the continuous intake of aceclofenac and tolperisone in combination with kinesiotherapy could relieve pain syndrome and enhance motor activity.Conclusion. More than half of the patients with CNLBP had MFPS only or concurrent with joint pathology (FS and FJs). The changes found in the back muscle biopsy specimens of patients with CNLBP are potentially reversible and can be reversed during kinesiotherapy.

Back pain in terms of socio-economic losses over the past 5 years has come to the first place among the causes of disability, and therefore the problem of rapid effective anesthesia and rehabilitation of this large group of patients is topical. In most cases, the main sources of back pain are the structures of the musculoskeletal system, and the reasons are their microtraumatization due to sudden unprepared movements, prolonged stay in a static position, heavy physical labor. The task of clinical and instrumental examination is to exclude specific causes of dorsalgia. It is also important to present the results of the survey in an accessible form, in particular to correctly interpret the data from neuroimaging research methods. Adequate anaesthesia for acute back pain, informing the patient about the favorable prognosis of the disease and early motor activation are essential to prevent the transition of the physiological feeling of pain into the pathological process - chronic pain syndrome. When dealing with chronic pain, the interaction of specialists of different profiles in the multidisciplinary team is required. Kinesiotherapy, ergotherapy, cognitive-behavioural therapy are the main methods of non-drug treatment of lower back painIt is recommended that the patient maintains the usual level of physical activity and then increases it. It is necessary to teach the patient to correctly perform movements in the social, professional and domestic spheres, to explain how to avoid unsafe movements that can provoke dorsalgia. The article presents the observation of a patient with chronic back pain. Success in treatment has been achieved through effective anesthesia through rational selection of non-steroidal anti-inflammatory drugs (Dexalgin), local administration of local anesthetics to overcome kinesiophobia, and a combination of cognitive-behavioural therapy, kinesiotherapy, and ergotherapy.

Chronic nonspecific low back pain (LBP) is the most common cause of disability and a lower quality of life in modern society.Objective: to discuss the feasibility of identifying the causes of chronic nonspecific LBP and in the case of detection of damage to the facet joint (FJ) or sacroiliac joint (SIJ), use of nonsteroidal anti-inflammatory drugs (NSAIDs), and injection of anesthetics and glucocorticoids into the region of the FJ or SIJ.Patients and methods. A total of 121 female patients aged 22 to 59 years with chronic nonspecific LBP were followed up. A FJ lesion was found in 53 (43.8%) patients. The patients were informed of a favorable disease prognosis, had motor activity recommendations, and were also prescribed NSAIDs and muscle relaxants. Twenty-eight (23%) patients achieved a clinically significant analgesic effect within 2 weeks; the remaining 93 (77%) patients received combination therapy with anesthetics injected into the region of the FJ and SIJ.Results and discussion. The basis for successful personified therapy in these patients is shown to be adequate diagnosis by identifying of the prevailing sources of pain impulses (triggers), and by using minimally invasive diagnostic methods, such as local injection of a local anesthetic solution into the suspected pain trigger. The high efficiency of combination therapy for chronic nonspecific LBP, which included anesthetics injected into the region of the FJ and SIJ, and is largely associated with rapid pain elimination, which is of great psychological importance. The central mechanisms of action of NSAIDs, etoricoxib in particular, are discussed.Conclusion. Thus, elucidation of the causes of chronic nonspecific LBP in a patient makes it possible to recommend personalized therapy aimed at eliminating not only the symptoms, but also the underlying cause of the disease. The use of etoricoxib for FJ lesion, which shows the highest analgesic efficacy in patients with osteoarthritis is pathogenetically justified and should be combined with nondrug treatments.

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.

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.

Non-specific back pain continues to be one of the leading causes of financial and economic costs in developed countries. The increasing popularity of interventional methods of pain treatment is linked to the high efficiency and rapid arresting of the disease symptoms. However, the use of invasive methods can be fraught with serious complications, especially when doctors do not understand the mechanisms for operation of drugs and make mistakes in the choice of therapy. A comprehensive, personalized approach to treating the patient with back pain requires, above all, the choice of non-invasive and safest methods of prevention, treatment and rehabilitation.

Healthcare and socio-economic significance of back pain is determined by the fact that it is one of the most common complaints of patients in outpatient and hospital settings resulting in temporary disability. In view of the etiological factor, musculoskeletal back pain is subdivided into specific and non-specific. The article discussed neurophysiological aspects of pain, mechanisms of development and clinical manifestations of lumbodynia. As pathogenetic treatment of musculoskeletal back pain, we examined the use of systemic and topical NSAIDs, muscle relaxants, antidepressants, as well as non-pharmacological methods including therapeutic exercises, physiotherapy, and cognitive behavioral therapy.