Chronic musculoskeletal pain in neurological practice

Abstract

Treatment of musculoskeletal back pain is an essential problem for doctors of many specialties, including neurologists. In some cases, the chronic course of the pain syndrome is accompanied with complaints and clinical manifestations characteristic of neuropathic pain in the absence of significant damage to the neural structures, which is explained by the mechanism of central sensitization. In this case, there may be diagnostic errors in determining the nature of the pain, which entails inadequate therapy that does not lead to the desired result.The presented clinical case is devoted to the treatment of exacerbation of chronic musculoskeletal pain. Treatment of the patient for a herniated disc complicated by radiculopathy, carried out earlier, did not lead to the desired result due to the inconsistency of the diagnosis, inadequacy and lack of systematic therapy. Based on the analysis of the physical and paraclinical studies, the diagnosis was changed to « Lower back pain. Myofascial pain syndrome. Toxic polyneuropathy. Herniated disc LV-SI. Residual radiculopathy S1». Therapeutic measures were adjusted in accordance with the diagnosis. In order to relieve the pain syndrome at the first stage, a combined drug Neurodiclovit, a muscle relaxant, a drug of the SYSADOA group, soft tissue techniques of manual therapy, phonophoresis with glucocorticosteroids, and cognitive behavioral therapy were used. The assessment of the patient’s condition carried out after 7 days showed the effectiveness of the treatment, which allowed to cancel the use of a nonsteroidal anti-inflammatory drug, a muscle relaxant and a glucocorticosteroid. At the post-treatment stage, the patient was prescribed a combination of B vitamins (Neuromultivitis) and therapeutic gymnastics, as well as continued therapy with a slowacting symptomatic agent and non-drug treatment methods. Relief of the pain syndrome in the absence of adverse events confirmed the adequacy and effectiveness of the therapy.The presented clinical case demonstrates the importance of placing emphasis at the stage of diagnosis, taking into account the data of clinical and paraclinical research methods, and also illustrates the possibility of successful conservative therapy for exacerbation of chronic musculoskeletal pain in the practice of a neurologist.