Management of patients with musculoskeletal back pain and comorbid anxiety
Musculoskeletal back pain (MSBP) is one of the most common reasons for seeking medical care. A socioeconomic burden of MSBP is significant, as it leads to reduced working capacity of the adult population. It is important to consider that the MSBP chronicity develops under the impact of “yellow flags”, i. e. factors that contribute to the central pain sensitization (pathophysiologically) and pain chronicification (clinically). The most common factor of pain chronicity is anxiety that underlies the development of pain catastrophization, maladaptive escape (“pain”) behaviour, and anxiety disorders. Anxiety symptoms can be expressed not only in the emotional, but also in the somatic, cognitive and behavioural sphere. Timely detection and management of anxiety in patients with chronic MSBP improves the effectiveness of pain syndrome treatment. The chronic MSBP treatment requires a multidisciplinary approach, which comprises kinesiotherapy, cognitive behavioural therapy, and optimal pharmacotherapy. Evidence-based drugs include non-steroidal anti-inflammatory drugs, such as dexketoprofen, which can be prescribed for the treatment of chronic MSBP with a short course and at an average therapeutic dose. The efficacy and safety of dexketoprofen in the treatment of pain syndromes, data from clinical studies and a systematic review are discussed. The authors present their own experience in managing a patient with chronic nonspecific MSBP and anxiety. The “yellow flags” that led to the MSBP chronicity in the patient are provided. The effective multidisciplinary approach to the treatment of a patient with chronic MSBP and anxiety disorder is demonstrated.