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Algorithm for treating chronic back pain

Medical expert of the article

Orthopedist, onkoortoped, traumatologist
, medical expert
Last reviewed: 23.04.2024

The algorithm for treating chronic back pain is as follows:

  • Determination of the cause of pain and its pathophysiology;
  • Assessment of the intensity of pain syndrome;
  • Assessment of the physical and mental state of the patient. Accounting for comorbid disorders;
  • Monitoring the effectiveness of therapy;
  • Prophylaxis and correction of side effects.

In 1998, WHO proposed a so-called anesthesia staircase, demonstrating the principles of escalating analgesic treatment. Proposed originally for the treatment of cancer pain, this scheme has become universal.

  • Do not opioids: aspirin, paracetamol, NSAIDs
  • Weak opioids: tramadol, codeine, dihydrocodeine
  • Strong opioids: morphine, diamorphine, fentanyl, buprenorphine, oxycodone, hydromorphine

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

trusted-source[1], [2], [3], [4]


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