Diagnosis and treatment of dorsalgia in outpatient practice

Abstract

Dorsalgia − nonspecific back pain is the leader in the number of requests for medical help. Nonspecific musculoskeletal pain accounts for up to 80–90% of all pain syndromes. Back pain can be provoked by professional static-dynamic overloads, violations of the statics of the musculoskeletal system, exposure to cold and/or vibration, overweight, hereditary factors, etc. In outpatient practice, doctors often have to deal with various forms and clinical manifestations of dorsalgia. The leading role in the diagnosis is given to the physical examination of the patient. With the active collection of complaints and anamnesis, the doctor has the opportunity to identify the leading problem that prompted the patient to seek medical help, clarify the localization of the process, the time of occurrence and the sequence of symptoms, which allows you to fully imagine the picture of the disease and differentiate between simultaneously occurring nosologies. The identification of the affected structure, which is the root cause of musculoskeletal pain, does not affect the appointment of basic drug therapy, but it is absolutely necessary when conducting local injection therapy, as well as a number of non-drug treatment methods. Among the pharmacological drugs used to treat musculoskeletal pain, the priority remains for NSAIDs, the choice of which, first of all, is dictated by its safety. The favorable safety profile of Nimesil® (nimesulide) has been confirmed by numerous domestic and foreign studies. Nimesulide is registered in 50 countries for the treatment of pain syndromes, and is also used as an antipyretic and anti-inflammatory drug. According to the results of a study in the Russian Federation, Nimesil® (nimesulide) turned out to be the most frequently prescribed drug, which is due to its high effectiveness and ability to accumulate in therapeutic concentration in the focus of inflammation. In addition to pharmacotherapy, the treatment regimen for musculoskeletal pain should include, on a parity basis, non-drug treatment methods that allow correction of pathobiomechanical changes. If ignored, in many cases, drug anesthesia does not lead to the desired effect, which can contribute to the chronization of pain. The described clinical case illustrates the simultaneous course of two variants of dorsalgia in the patient, different in localization, clinical manifestations, severity and duration of the course.