Chronic musculoskeletal low back pain: mistakes in patient management and optimization issues

Abstract

We present a clinical observation of a patient with chronic musculoskeletal low back pain (CMLBP), one of the most common conditions in neurological practice. Common mistakes in the management of such patients are highlighted. The patient had previously been incorrectly diagnosed with "osteochondrosis of the spine", the back pain was by mistake associated with "age-related" organic, degenerative-dystrophic changes in the spine, and only passive treatment methods were used in the treatment — various medications, massages, physiotherapy. The factors for the development and chronification of back pain were not evaluated or corrected, therapeutic exercises were not prescribed, the rules of ergonomics and physical activity during the day were not discussed, i.e. methods that have proven to be effective and are recommended for the treatment of CMLBP. Due to an inappropriate management, the patient developed misconceptions about the disease, catastrophizing the pain and incorrect and ineffective strategies for coping with the pain, which perpetuated the chronic course of the back pain. At the Clinic for Nervous Diseases at Sechenov University, the patient was offered a comprehensive treatment approach that included educational counselling, kinesiotherapy and pharmacotherapy. Based on the patient's medical and life history and the data of an objective examination, factors for the development and chronification of back pain were identified: long-term static postures at work at a computer, physical inactivity, increased body weight, neuro-orthopedic features (“flat back”), anxiety, catastrophizing of pain, pain behavior pattern. During the treatment process, all of the above factors were considered and corrected. Kinesiotherapy included therapeutic exercises, recommendations on ergonomics and daily activity, training in correct posture and kinesio-taping. The patient took dexketoprofen as a non-steroidal anti-inflammatory drug, which is effective and relatively safe for patients with back pain. As a result of the complex treatment, the patient's pain syndrome regressed, daily activity increased and her emotional state improved; observation over 6 months showed a lasting positive effect, increasing working capacity.