Chronic back pain as a spinal osteoarthritis manifestation: rationale and practice of symptomatic slow acting drugs for osteoarthritis use

Abstract

Chronic non-specific back pain (CNBP) is the most common pathology of the musculoskeletal system, affecting from 10 to 60% of the adult population in the world, causing severe suffering, disability and a significant deterioration in the quality of life. Osteoarthritis (OA) should be considered as one of the main reasons of the development of CNBP – inflammatory and degenerative changes in the facet and sacroiliac joints, as well as the spinal column itself (in particular, osteitis of the Modic 1 type). Spinal OA is accompanied by biomechanical disturbances, nociplastic (peripheral and central sensitization) and psycho-emotional changes that form a complete picture and various CNBP phenotypes.Recognizing the leading role of OA as the cause of CNBP, it is advisable to use the same therapeutic approaches in this syndrome as in OA of peripheral joints. In particular, it is necessary to consider the use of symptomatic slow acting drugs for osteoarthritis (SYSADOA) in CNBP as the main pathogenetic therapy.Alflutop is one of the most popular parenteral SYSADOA widely used in Russian practice. This drug has a good evidence base: this review presents data from 12 clinical trials of Alflutop in CNBP (n=1479), which confirmed its efficacy and safety.