Management of patients with musculoskeletal back pain and comorbid anxiety

Abstract

Musculoskeletal back pain (MSBP) is one of the  most  common  reasons  for seeking  medical  care. A socioeconomic burden  of MSBP is significant, as it leads  to reduced  working capacity of the adult  population.  It is important to consider  that  the MSBP chronicity develops  under the impact of “yellow flags”, i. e. factors that contribute to the central  pain sensitization (pathophysiologically) and pain chronicification  (clinically). The most common factor of pain chronicity is anxiety that underlies  the development  of pain  catastrophization, maladaptive escape  (“pain”)  behaviour,  and  anxiety  disorders.  Anxiety symptoms  can  be expressed not only in the emotional,  but also in the somatic, cognitive and behavioural sphere. Timely detection and management  of anxiety  in patients with  chronic MSBP improves  the  effectiveness of pain  syndrome  treatment. The chronic MSBP treatment requires  a multidisciplinary  approach,  which comprises  kinesiotherapy, cognitive  behavioural therapy, and optimal pharmacotherapy. Evidence-based drugs include  non-steroidal anti-inflammatory drugs, such as dexketoprofen, which can be prescribed  for the treatment of chronic MSBP with a short course and at an average  therapeutic dose. The efficacy and safety of dexketoprofen in the  treatment of pain syndromes, data  from clinical studies  and a systematic  review are discussed. The authors  present their own experience in managing  a patient  with chronic nonspecific MSBP and anxiety. The “yellow flags” that led to the MSBP chronicity in the patient  are provided. The effective  multidisciplinary  approach  to the treatment of a patient with chronic MSBP and anxiety disorder is demonstrated.