Logistics of technologies in the framework of personalized rehabilitation of patients with chronic back pain

BACKGROUND: Lower back pain covers a large part of the population and is common in all age groups. Scientific research shows not only significant medical and social, but also high economic costs associated with this problem.

AIM: optimization of diagnostic and rehabilitation approaches in the management of patients with chronic back pain.

MATERIALS AND METHODS: 126 patients participated in the ongoing single-center prospective cohort study. The assessment of neuroorthopedic examination and neuropsychological status, laboratory, neuroimaging (magnetic resonance tomography) and neurophysiological studies of patients, filling out scales and questionnaires, consultations of related specialists were carried out. 42 patients with a clinical picture of neuropathic pain underwent electromyography stimulation, and 16 of them underwent a transcranial magnetic stimulation study. Within the framework of the pilot project, 22 patients with identified undesirable side reactions when taking non-steroidal anti-inflammatory drugss underwent pharmacogenetic research and consulting by a medical geneticist to select personalized non-steroidal anti-inflammatory drugs pharmacotherapy. Based on the results of the examinations, taking into account the nature of the course of the disease and the prevailing pathogenetic variant of pain, an individual rehabilitation program was developed. To assess the individual rehabilitation program, the data obtained within each group were compared with the results of treatment of patients with the traditional approach (retrospective analysis of medical histories).

RESULTS: The study included 126 patients (67 men and 59 women) with lower back pain persisting for more than 3 months. The average age was 50.06±1.25 years. The average duration of the disease was 10±2.19 months. The patients were divided into 3 groups: the first group of 30 patients with back pain and the predominance of a dysfunctional component; the second group of 78 patients with neuropathic pain syndrome (radiculopathy); the third group included 18 patients with nociceptive variant of back pain. As a result of the pathogenetically directed rehabilitation program, it was possible to increase patients' adherence to treatment and compliance with recommendations (p <0.05) and reduce the need for surgical treatment in patients with discogenic radicular syndrome (p <0.05).

CONCLUSION: The multi-vector multidisciplinary approach with a pathogenetic focus on identifying and treating clinical and pathogenetic variants of pain and the causes of its persistence is the most effective, and physical rehabilitation methods are well combined with each other and with pharmacotherapy, potentiating each other's effects.