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Algorithm for the treatment of chronic back pain

Medical expert of the article

Orthopedist, onco-orthopedist, traumatologist
, medical expert
Last reviewed: 08.07.2025

The treatment algorithm for chronic back pain is as follows:

  • Determining the cause of pain and its pathophysiology;
  • Assessment of pain intensity;
  • Assessment of the patient's physical and mental state. Consideration of comorbid disorders;
  • Monitoring the effectiveness of therapy;
  • Prevention and correction of side effects.

In 1998, the WHO proposed the so-called pain relief ladder, which demonstrates the principles of escalating analgesic treatment. Initially proposed for the treatment of cancer pain, this scheme has become universal.

  • Non-opioids: aspirin, paracetamol, NSAIDs
  • Weak opioids: tramadol, codeine, dihydrocodeine
  • Strong opioids: morphine, diamorphine, fentanyl, buprenorphine, oxycodone, hydromorphine

Adjuvants: antidepressants, anticonvulsants, steroids, muscle relaxants (eg, tizanidine, baclofen), bisphosphonates (eg, zoledronic acid, alendronic acid, ibandronic acid), calcitonin, exercise, physiological support, thermotherapy, traditional medicine, hydrotherapy, acupuncture.

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