Management of acute nonspecific lumbosacral pain: modern guidelines and new approaches in pharmacotherapy

Abstract

Acute nonspecific lumbosacral pain (LSP) is one of the most common reasons people visit their doctor. This disease has a favourable prognosis, however, the low back pain can progress to a chronic course, if the treatment is inadequate. In this regard, timely diagnosis and adequate treatment of acute nonspecific LSP are of great clinical importance. The diagnosis of acute non-specific LSP is established after discogenic radiculopathy, lumbar stenosis and other specific causes of back pain have been excluded. 15 clinical guidelines for the treatment of acute nonspecific LSP were reviewed in 2018, and it was concluded that they match in basic therapeutic principles. The basis for effective treatment of acute nonspecific LSP includes informing the patient about a favourable prognosis of pain, the recommendation to maintain an active lifestyle and optimal pharmacotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving the low back pain. The choice of NSAIDs depends on the concomitant diseases of the patient and the risk of side effects. If NSAIDs provide poor efficacy, a drug from the muscle relaxants group can be added. NSAIDs combined with B vitamins (thiamine, pyridoxine, cyanocobalamin) is a new direction in the pharmacotherapy of acute non-specific LSP. The article discusses the results of clinical trials of the efficacy and safety of NSAIDs combined with B vitamins, the advantages of this combination in patients with LSP. The authors analyse the use of B vitamins-containing Milgamma as a co-analgesic drug combined with NSAIDs in acute nonspecific back pain.