ABSTRACT

Chronic back pain is an actual problem of clinical medicine, the pathogenesis of which includes peripheral nociceptive stimulation, peripheral and/or central inflammation, abnormality of the central pain modulation network and mixed onset of various pathological mechanisms. Sources of nociceptive signal generation include the intervertebral disc, muscles, fasciae, facet joints, sacroiliac joints, pubic symphysis, ligaments and joint capsule, and other structures that contain nociceptors. Any event that causes tissue degeneration activates a massive inflammatory response that infiltrates the MPD, joints, muscles, fascia and other tissues, stimulates nociceptive receptors to produce inflammatory substances, which directly damages the nerve root and causes pain.
Simultaneously, the damaged MPD and endplate stimulate pathological and invasive growth and proliferation of vessels and nerves in the MPD. Increasing evidence also suggests that systemic inflammation plays a crucial role in the pathogenesis of chronic back pain. The central mechanism of back pain involves altered sensory processing in the brain. Dysfunction of the descending pain modulation system results in amplification of pain information in the brain. Since monotherapy for chronic back pain is not optimal, it is necessary to promote the comprehensive treatment recommended by current international clinical guidelines and it is reasonable to combine several therapies to improve the clinical effect of therapy. The combination of Tizanidine and Mirtazapine is an effective pharmacotherapy for chronic back pain.

KEYWORDS: Chronic back pain, pathogenesis of dorsalgia, Tizanidine, Mirtazapine

For citation: Rachin A.P., Sharov M.N., Karpov S.M., Rachin S.A., Prokofieva Y.S., Parsamyan R.R. Chronic Back Pain: From Pathogenesis to Adequate Therapy. Comorbidity Neurology. 2024; 1 (3): 85-93. https://doi.org/10.62505/3034-185x-2024-1-3-85-93

*For correspondence: Andrei P. Rachin, Dr. Sci. (Med.), Professor, President of the National Association of Experts in Comorbid Neurology, Moscow, Russia, e-mail: 7851377@gmail.com.

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ADDITIONAL INFORMATION

Andrei P. Rachin, Dr. Sci. (Med.), Professor, President of the National Association of Experts in Comorbid Neurology, Moscow, Russia. E-mail: 7851377@gmail.com. ORCID: https://orcid.org/0000-0003-4266-0050

Mikhail N. Sharov, Dr. Sci. (Med.), Professor, Department of Nervous Diseases, Faculty of Dentistry, Russian University of Medicine, Moscow, Russia. E-mail: 6112286@mail.ru. ORCID: https://orcid.org/0000-0001-9634-346X

Sergey M. Karpov, Dr. Sci. (Med.), Professor, Head of the Department of Neurology, Neurosurgery and Medical Genetics, Stavropol State Medical University, Stavropol, Russia. E-mail: karpov25@rambler.ru. ORCID: https://orcid.org/0000-0003-1472-6024 

Sergei A. Rachin, Executive Director, National Association of Experts in Comorbid Neurology, Moscow, Russia. E-mail: Rachin.sergei@gmail.com. ORCID: https://orcid.org/0000-0001-9771-4621

Yulia S. Prokofieva, postgraduate student of the Department of Nervous Diseases, Faculty of Dentistry, Russian University of Medicine; Research Center of Neurology, Moscow, Russia. E-mail: pryulek@yandex.ru. ORCID: https://orcid.org/0000-0003-4454-7174

Ruzanna R. Parsamyan, Cand. Sci. (Med.), Associate Professor of the Department of Neurology named after. K.N. Tretyakova; Senior Researcher at the Department of Basic Research in Neurocardiology, Research Institute of Cardiology, Saratov State Medical University named after V.I. Razumovsky; Head of Clinic Pain, Saratov, Russia. E-mail: kvl.prr@mail.ru. ORCID: https://orcid.org/0000-0002-6509-5958

Author contributions. All authors confirm the compliance of their authorship, according to international ICMJE criteria (all authors made a significant contribution to the development of the concept, research and preparation of the article, read and approved the final version before publication). Rachin S.A., Prokofieva Yu.S., Parsamyan R.R. – searched for suitable literature; Rachin A.P., Sharov M.N., Karpov S.M. – correcting the text in accordance with the basic requirements.

Funding. This study was supported by any external sources of funding.

Disclosure. The authors declare that they have competing interests.

The content is available under the Creative Commons Attribution 4.0 License.

©2024. Andrei P. Rachin, Mikhail N. Sharov, Sergey M. Karpov et al.