Chronic low back pain (CLBP) is the most common chronic pain syndrome that causes deterioration of the quality of life and disability. Anxiety and depressive disorders are significantly more common in patients with CLBP. The negative impact of CLBP on cognitive abilities and sleep was revealed. Treatment of patients with CLBP should be started with non-pharmacological methods, including an educational program, kinesiotherapy, and cognitive behavioral therapy. Antidepressants are prescribed for CLBP to reduce the severity of associated anxiety and depressive disorders, improve sleep and relieve pain. The efficacy and safety of sertraline (Serenatа) in CLBP, its additional neurochemical mechanisms of action due to its effect on dopamine reuptake, interaction with sigma receptors, low incidence of side effects, and high adherence of patients to therapy are discussed.
Background. Fibromyalgia (FM) is manifested by chronic widespread pain syndrome, sleep disorders, fatigue and subjective cognitive impairment. There is a late diagnosis of FM in different countries; there is no data on the typical medical practice of managing patients with FM in our country. Aim. To analyse the previous typical practice of managing patients with FM. Materials and methods. Fifty three patients with FM (47 women and 6 men) were under observation; the average age was 46.814.6 years. The duration of FM symptoms (years), the intensity of pain syndrome according to a Numerical Rating Scale (NRS), quality of life using The Revised Fibromyalgia Impact Questionnaire (FIQR), emotional state according to the Hospital Anxiety and Depression Scale (HADS), and treatment were evaluated. Results. The duration of symptoms before the diagnosis of FM was 7.0 (2.015.0) years. The intensity of pain during the initial examination in patients with FM according to NRS 7.11.9 points, the effect on the quality of life of patients with FM according to FIQR 54.918.4 points. The majority of patients (85%) were not diagnosed with FM before hospitalization. There were no statistically significant differences in the intensity of pain (p=0.478), the level of quality of life (p=0.611), the level of anxiety (0.159) and depression (0.347) in the groups of patients who had or did not have a diagnosis of FM. Conclusion. FM is rarely diagnosed in our country, even in cases of diagnosis, patients in many cases do not receive effective treatment, which reflects the low awareness of doctors about modern methods of diagnosis and treatment of FM.
Psychological treatment methods can be used to reduce the intensity of the pain syndrome, the influence of psychological, social factors, comorbide disorders, and to improve the quality of life in patients with chronic back pain (CPS, i.e. chronical pain syndrome). The methods of assessing the psychological state, the effectiveness of various psychological methods are discussed. It is noted that the effectiveness of cognitive-behavioral therapy, mindfulness (mindfulness therapy), relaxation method and biofeedback is confirmed by the results of randomized controlled studies for CPS. Psychological methods of treatment for pain should be widely used in the management of patients with CPS.
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