Examination of a patient with chronic low back pain (LBP) is aimed at eliminating its specific cause and assessing the social and psychological factors of chronic pain. The diagnosis of chronic nonspecific (musculoskeletal) LBP is based on the exclusion of a specific cause of pain, discogenic radiculopathy, and lumbar stenosis. It is advisable to identify possible pain sources: pathology of intervertebral disc pathology, facet joints, and sacroiliac joint and myofascial syndrome.An integrated multidisciplinary approach (a high level of evidence), including therapeutic exercises, physical activity optimization, psychological treatments (cognitive behavioral therapy), an educational program (back pain school for patients), and manual therapy, is effective in treating chronic musculoskeletal LBP. For pain relief, one may use nonsteroidal anti-inflammatory drugs in minimally effective doses and in a short cycle, muscle relaxants, and a capsaicin patch, and, if there is depressive disorder, antidepressants (a medium level of evidence). Radiofrequency denervation or therapeutic blockages with anesthetics and glucocorticoids (damage to the facet joints, sacroiliac joint), back massage, and acupuncture (a low level of evidence) may be used in some patients.Therapeutic exercises and an educational program (the prevention of excessive loads and prolonged static and uncomfortable postures and the use of correct methods for lifting weights, etc.) are recommended for preventive purposes.

7 620028, Екатеринбург, ул. Репина, 3 У пациента с острой поясничной болью (ПБ) проводят оценку жалоб и данных анамнеза, краткое соматическое и неврологическое обследование, определяют наличие симптомов опасности. Диагноз острой неспецифической (скелетно-мышечной) ПБ основывается на исключении специфической причины боли (потенциально опасного заболевания), дискогенной радикулопатии и поясничного стеноза. В случаях типичной скелетно-мышечной боли, отсутствия симптомов опасности не рекомендуются проведение рентгенографии, рентгеновской компьютерной томографии, магнитно-резонансной томографии в первые 4 нед заболевания. Целесообразность их выполнения рассматривается при сохранении ПБ сверх этого времени. Пациент с острой неспецифической (скелетно-мышечной) ПБ должен быть проинформирован о благоприятном исходе заболевания, необходимости сохранять физическую и социальную активность, избегать постельного режима, при возможности продолжать профессиональную деятельность. Для облегчения боли можно использовать нестероидные противовоспалительные препараты в минимально эффективных дозах и коротким курсом, а также миорелаксанты (средний уровень доказательности). Части пациентов целесообразно назначить мануальную терапию и массаж спины (низкий уровень доказательности). Для предупреждения рецидивов ПБ рекомендуются образовательная программа (профилактика чрезмерных нагрузок, длительного пребывания в статических и неудобных позах, правильные способы подъема тяжестей и др.) и вне периода обострения -лечебная гимнастика. Ключевые слова: острая неспецифическая (скелетно-мышечная) поясничная боль; рекомендации по диагностике, лечению и профилактике. Контакты: Вероника Александровна Головачева; xoxo.veronicka@gmail.com Для ссылки: Парфенов ВА, Яхно НН, Кукушкин МЛ и др. Острая неспецифическая (скелетно-мышечная) поясничная боль. Рекомендации Российского общества по изучению боли (РОИБ). Неврология, нейропсихиатрия, психосоматика. 2018;10(2):4-11. Acute nonspecific (musculoskeletal) low back pain Guidelines of the Russian Society for the Study of Pain (RSSP)

Functional magnetic resonance tomography provides a non-invasive method for mapping the cerebral cortex. The aim of the present work was to assess the potential and suitability of this method in a series of brain disorders. Studies were performed on 32 volunteers (mean age 37.8 +/- 20.9 years) and 16 patients with tumors of the cerebral cortex (mean age 36.2 +/- 24.2 years). Initial functional images were processed by statistical methods. Computed activation maps were superimposed on anatomical images. In 89% of cases, functional magnetic resonance tomography allowed the motor cortex and Broca's area to be localized; in almost 69%, the method impinged on the therapeutic tactics used in patients with cerebral cortex lesions. Thus, functional magnetic resonance tomography can be used in clinical conditions to obtain information not yielded by other diagnostic methods and which can be used to plan the neurosurgical treatment of patients with supratentorial brain tumors with maximum preservation of cerebral cortex function. Assessments of the state of the motor and speech areas by this tomographic method has potential applications in neurosurgery and neurophysiology.

Objective: to analyze the typical medical practice management of patients with carpal tunnel syndrome (CTS), to evaluate the efficiency of surgical treatment, and to identify factors influencing the successful outcomes of surgical treatment.Patients and methods. The investigation enrolled 85 patients (14 men and 71 women; mean age, 62±10.8 years). Previous diagnosis and treatment of patients were assessed in other healthcare facilities. All patients underwent median nerve decompression. The efficiency of surgical treatment was assessed according to the Boston Carpal Tunnel Questionnaire (BCTQ) and a visual analogue scale for pain before and 1, 3, 6, and 12 months after surgery.Results and discussion. Informative diagnostic tests are rarely performed in patients with CTS, but cervical spine neurovisualization is often unreasonably prescribed. Erroneous diagnoses (predominantly those of cervical spine osteochondrosis (46%), and diabetic neuropathy (6%)) are made frequently (60%) in patients with CTS; the latter receive ineffective treatment for a long time. Surgical treatment in reducing pain and improving hand functionality is noted to be highly effective. The mean BCTQ score decreased from 2.81±0.68 to 1.62±0.55 and 1.24±0.41 at 1 and 12 months, respectively (p<0.05), the mean functional state score dropped from 2.92±0.78 to 2.4±0.72 and 1.46±0.57, respectively (p<0.05). Permanent numbness, subjective weakness, thenar muscle atrophy, Stage III CTS, and diabetes mellitus are predictors for less pronounced improvement in BCTQ scores after surgery (p<0.05).Conclusion. Physicians are noted to be unaware of the manifestations of CTS and effective methods for its diagnosis and treatment. Decompression surgery is shown to be a highly effective procedure in patients with CTS following 1 and 12 months.

Objective: to investigate the short- and long-term results of surgical median nerve decompression via classical and minimally invasive approaches in patients with carpal tunnel syndrome (CTS), as well as factors that influence surgical outcomes. Patients and methods. The investigation enrolled 70 patients (13 men and 57 women) aged 36 to 84 years (mean age, 62±10.8 years) who had undergone median nerve decompression. Surgery was performed in the classical way in 35 patients (Group 1) and via a minimally invasive access in the remaining 35 patients (Group 2). The efficiency of treatment was evaluated using the Boston Carpal Tunnel Questionnaire (BCTQ) and a visual analog scale for pain before and 1, 3, 6, and 12 months after surgery, as well as from patient satisfaction with surgical outcomes. Results. No complications of surgical treatment were detected. There was a marked reduction in pain and other neuropathic disorders just 1 month after surgery and a substantial hand functional improvement following 6 months. After 12 months, in Group 1, the mean BCTQ Symptom Severity Scale and Functional Deficit Scale scores decreased from 2.76 to 1.15 (p≤0.01) and from 2.72 to 1.24 (p≤0.01), respectively; in Group 2, these dropped from 2.86 to 1.14 (p≤0.01) and from 2.95 to 1.24 (p≤0.01), respectively. Complete recovery from sensory problems occurred in 24 (69%) patients in Group 1 and in 25 (71%) patients in Group 2; their partial recovery was observed in 11 (31%) and 10 (29%) patients in these groups, respectively. One 1 month following decompression, the patients in Group 1 had more severe pain syndrome than those in Group 2; these differences became statistically insignificant after 6 months. The patients were found to be highly satisfied with surgical treatment. Permanent numbness, subjective weakness, thenar muscle atrophy, stage III CTS, and diabetes mellitus (DM) were predictors for less pronounced improvement in BCTQ scores after surgical treatment (p<0.05). The paper describes a clinical case that achieved full postoperative occupational and home rehabilitation. Conclusion. The patients with CTS were observed to have a marked reduction in pain and other neuropathic disorders just one month after surgical decompression and a substantial hand functional improvement following 6 months. The benefit from a minimally invasive access is less severe pain syndrome at 1 month after surgery. The predictors of less successful results of surgery are age (the older the patient is, the greater likelihood of having a worse result), permanent numbness, subjective hand weakness, thenar muscle atrophy, DM, and stage III CTS.