Gerhard Müller-Schwefe1, Bart Morlion2, Karsten Ahlbeck3, Eli Alon4, Stefano Coaccioli5, Flaminia Coluzzi6, Frank Huygen7, Wolfgang Jaksch8, Eija Kalso9, Magdalena Kocot-Kępska10, Hans-Georg Kress11, Ana Cristina Mangas12, Cesar Margarit Ferri13, Philippe Mavrocordatos14, Andrew Nicolaou15, Concepción Pérez Hernández16, Joseph Pergolizzi17, Michael Schäfer18, Patrick Sichère19. 1. a Schmerz- und Palliativzentrum , Göppingen , Germany. 2. b University Hospitals Leuven , Belgium. 3. c Capio St Görans Hospital , Stockholm , Sweden. 4. d Universitätsspital Zurich , Zurich , Switzerland. 5. e Santa Maria General Hospital , Terni , Italy. 6. f Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy. 7. g University Hospital , Rotterdam , The Netherlands. 8. h Wilhelminenspital der Stadt Wien , Austria. 9. i Pain Clinic, Department of Anaesthesiology, Intensive Care and Pain Medicine , University of Helsinki, and Helsinki University Hospital , Finland. 10. j Department of Pain Research and Treatment , Collegium Medicum Jagiellonian University , Kraków , Poland. 11. k Department of Special Anaesthesia and Pain Therapy , Medizinische Universität/AKH Wien , Vienna , Austria. 12. l Hospital de Santo André , Leiria , Portugal. 13. m Hospital General Universitario de Alicante , Spain. 14. n Clinique Cecil , Lausanne , Switzerland. 15. o St. Georges Hospital , London , UK. 16. p Hospital Universitario de la Princesa , Madrid , Spain. 17. q Naples Anesthesia and Pain Associates , Naples , FL , USA. 18. r Department of Anaesthesiology and Intensive Care Medicine , Charité University Berlin, Campus Virchow Klinikum , Berlin , Germany. 19. s Hôpitaux de Saint-Denis , Paris , France.
Abstract
Chronic low back pain: Chronic pain is the most common cause for people to utilize healthcare resources and has a considerable impact upon patients' lives. The most prevalent chronic pain condition is chronic low back pain (CLBP). CLBP may be nociceptive or neuropathic, or may incorporate both components. The presence of a neuropathic component is associated with more intense pain of longer duration, and a higher prevalence of co-morbidities. However, many physicians' knowledge of chronic pain mechanisms is currently limited and there are no universally accepted treatment guidelines, so the condition is not particularly well managed. DIAGNOSIS: Diagnosis should begin with a focused medical history and physical examination, to exclude serious spinal pathology that may require evaluation by an appropriate specialist. Most patients have non-specific CLBP, which cannot be attributed to a particular cause. It is important to try and establish whether a neuropathic component is present, by combining the findings of physical and neurological examinations with the patient's history. This may prove difficult, however, even when using screening instruments. Multimodal management: The multifactorial nature of CLBP indicates that the most logical treatment approach is multimodal: i.e. integrated multidisciplinary therapy with co-ordinated somatic and psychotherapeutic elements. As both nociceptive and neuropathic components may be present, combining analgesic agents with different mechanisms of action is a rational treatment modality. Individually tailored combination therapy can improve analgesia whilst reducing the doses of constituent agents, thereby lessening the incidence of side effects. CONCLUSIONS: This paper outlines the development of CLBP and the underlying mechanisms involved, as well as providing information on diagnosis and the use of a wide range of pharmaceutical agents in managing the condition (including NSAIDs, COX-2 inhibitors, tricyclic antidepressants, opioids and anticonvulsants), supplemented by appropriate non-pharmacological measures such as exercise programs, manual therapies, behavioral therapies, interventional pain management and traction. Surgery may be appropriate in carefully selected patients.
Chronic low back pain: Chronic pain is the most common cause for people to utilize healthcare resources and has a considerable impact upon patients' lives. The most prevalent chronic pain condition is chronic low back pain (CLBP). CLBP may be nociceptive or neuropathic, or may incorporate both components. The presence of a neuropathic component is associated with more intense pain of longer duration, and a higher prevalence of co-morbidities. However, many physicians' knowledge of chronic pain mechanisms is currently limited and there are no universally accepted treatment guidelines, so the condition is not particularly well managed. DIAGNOSIS: Diagnosis should begin with a focused medical history and physical examination, to exclude serious spinal pathology that may require evaluation by an appropriate specialist. Most patients have non-specific CLBP, which cannot be attributed to a particular cause. It is important to try and establish whether a neuropathic component is present, by combining the findings of physical and neurological examinations with the patient's history. This may prove difficult, however, even when using screening instruments. Multimodal management: The multifactorial nature of CLBP indicates that the most logical treatment approach is multimodal: i.e. integrated multidisciplinary therapy with co-ordinated somatic and psychotherapeutic elements. As both nociceptive and neuropathic components may be present, combining analgesic agents with different mechanisms of action is a rational treatment modality. Individually tailored combination therapy can improve analgesia whilst reducing the doses of constituent agents, thereby lessening the incidence of side effects. CONCLUSIONS: This paper outlines the development of CLBP and the underlying mechanisms involved, as well as providing information on diagnosis and the use of a wide range of pharmaceutical agents in managing the condition (including NSAIDs, COX-2 inhibitors, tricyclic antidepressants, opioids and anticonvulsants), supplemented by appropriate non-pharmacological measures such as exercise programs, manual therapies, behavioral therapies, interventional pain management and traction. Surgery may be appropriate in carefully selected patients.
Authors: Ibrahim Alrashdi; Amal Alsubaiyel; Michele Chan; Emma E Battell; Abdel Ennaceur; Miles A Nunn; Wayne Weston-Davies; Paul L Chazot; Ilona Obara Journal: Front Pharmacol Date: 2022-03-08 Impact factor: 5.810