Back pain in young people: approaches to diagnosis and treatment

Back pain in young people (14–35 years old) may have causes rooted in adolescence or even earlier childhood. Diagnosis in this case can present considerable difficulties for a therapist and general practitioner, since “nonspecific back pain” may hide pathological conditions inherent in childhood. The degree of compensation for scoliosis, hereditary abnormalities in the development of the spine, the severity of early degenerative processes, and metabolic diseases of the skeleton that were not identified during school years determine a non-standard scope of diagnostic and therapeutic measures for the doctor. These include collecting a family history and screening the patient for the presence of inflammatory back pain according to the 2009 ASAS criteria, a survey on the hospital anxiety and depression scale, a morphometric assessment of the stigma of dysembryogenesis and an assessment of hypermobility syndrome, advanced laboratory diagnostics with determination of indicators of mineral-calcium metabolism, X-ray diagnostics with functional tests, the use of magnetic resonance imaging or computed tomography of the spine in the absence of radicular symptoms. The patient’s active involvement in non-drug restorative treatment significantly improves his prognosis, and pharmacological support should have a health-saving direction and consider the presence of low-intensity inflammation in the pathogenesis of the disease. The choice of therapy for a reproductively active cohort of patients is made in favor of drugs with the maximum safety profile, which include, among others, selective non-steroidal anti-inflammatory drugs.

1. Ikeda T., Sugiyama K., Aida J. et al. Socioeconomic inequalities in low back pain among older people: the JAGES cross-sectional study. Int J Equity Health 2019;18(1):15. DOI: 10.1186/s12939-019-0918-1

2. Hillman M., Wright A., Rajaratnam G. et al. Prevalence of low back pain in the community: implications for service provision in Bradford, UK. J Epidemiol Community Health 1996;50(3): 347–52. DOI: 10.1136/jech.50.3.347

3. Smith E., Hoy D.G., Cross M. et al. The global burden of other musculoskeletal disorders: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;73(8):1462–9. DOI: 10.1136/annrheumdis-2013-204680

4. Miñana-Signes V., Monfort-Pañego M., Bosh-Bivià A.H., Noll M. Prevalence of low back pain among Primary School Students from the city of Valencia (Spain). Healthcare (Basel) 2021;9(3):270. DOI: 10.3390/healthcare9030270

5. Airaksinen O., Brox J.I., Cedraschi C. et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;15(Suppl 2):S192–300. DOI: 10.1007/s00586-006-1072-1

6. Klimov L.V., Akarachkova Е.S. Back pain. Age-related metamorphoses of pain. Clinical guidance. Moscow: Publication of the International Society for the Study and Effective Control of Stress and Related Disorders, 2023. (In Russ.).

7. Jones G.T., Macfarlane G.J. Epidemiology of low back pain in children and adolescents. Arch Dis Child 2005;90(3):31–6. DOI: 10.1136/adc.2004.056812

8. Pravdyuk N.G., Shostak N.A., Novikova A.V. Back pain in young people: clinical and instrumental characteristics taking into account long-term observations. Lechebnoe delo = General Medicine 2021;3:81–91. (In Russ.). DOI: 10.24412/2071-5315-2021-12363

9. Achar S., Yamanaka J. Back Pain in Children and Adolescents. Am Fam Physician 2020;102(1):19–28. PMID: 32603067

10. Dementsov A.B. Perthes disease: etiology, clinical picture, pathogenesis, treatment methods. Medicinskie novosti = Medical Lection news 2013(7):18–24. (In Russ.).

11. Vyortkin A.L., Shamuilova M.M., Knorring G.Yu. et al. Prevention and treatment of back pain: Expert consensus. Doctor.Ru = Doctor. Ru 2020;19(9):45–52. (In Russ.) DOI: 10.31550/1727-2378-2020-19-9-45-52

12. Klimov L.V., Akarachkova Е.S. Back pain in children and adolescents. Clinical recommendations. St. Petersburg: Scythiaprint; Moscow: Profmedpress, 2021. (In Russ.).

13. Bochkova A.G., Levshakova A.V. Why is the diagnosis of ankylosing spondylitis made late? Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, neuropsychiatry, psychosomatics 2009; 1(3–4):19–24. (In Russ.). DOI: 10.14412/2074-2711-2009-50

14. Raychaudhuri S.P., Deodhar A. The classification and diagnostic criteria of ankylosing spondylitis. J Autoimmun 2014;48–9:128–33. DOI: 10.1016/j.jaut.2014.01.015

15. Kiltz U., van der Heijde D., Mielants H. et al. PARE/EULAR patient initiative group. ASAS/EULAR recommendations for the management of ankylosing spondylitis: the patient version. Ann Rheum Dis 2009;68(9):1381–6. DOI: 10.1136/ard.2008.096073

16. Shostak N.A., Pravdyuk N.G., Novikova A.V. et al. Back pain in young people: focus on spondyloarthritis (clinical observation). Poliklinika = Polyclinic 2020;2:22–8. (In Russ.). DOI: 10.24412/2071-5315-2021-12363

17. Vadalà G., Russo F., Battisti S. et al. Early intervertebral disc degeneration changes in asymptomatic weightlifters assessed by t1ρ-magnetic resonance imaging. Spine (Phila Pa 1976) 2014;39(22):1881–6. DOI: 10.1097/BRS.0000000000000554

18. Aebi M. The adult scoliosis. Eur Spine J 2005;14(10):925–48. DOI: 10.1007/s00586-005-1053-9

19. Charnashtan D.V., Tsukanov A.N., Nikolayev V.I. et al. Diagnosis of scoliosis and ways to optimize it. A practical guide for doctors. Gomel, 2015. (In Russ.). Available at: https://www.rcrm.by/download/posob_doctor/2015-12.PDF

20. Zaydman A.M., Fomichev N.G., Kalashnikova Е.V., Aksenovich T.I. Mechanisms of inheritance of Sheyermann’s disease. Khirurgiya pozvonochnika = Spinal Surgery 2005;(4):77–81. (In Russ.).

21. Kremer Yu. Diseases of the intervertebral discs. Trans. from English/ Ed. by V.A. Shirokov. Moscow: MEDpress-inform, 2013. (In Russ.).

22. Kolesov S.V., Snetkov A.A., Sazhnev M.L. Surgical treatment of spinal deformity in achondroplasia. Khirurgiya pozvonochnika = Spinal surgery 2013;4:17–22. (In Russ.).

23. Radenska-Lopovok S.G., Timakova A.A., Kuzin A.V., Murylev V.Yu. Alkaptonuria is morphological changes in joint tissue. Literature review and own observations. Arkhiv patologii = Pathology archive 2020;82(4):41–6. (In Russ.). DOI: 10.17116/patol20208204141

24. Rossi V., Lee B., Marom R. Osteogenesis imperfecta: advancements in genetics and treatment. Curr Opin Pediatr 2019;31(6):708–15. DOI: 10.1097/MOP.0000000000000813

25. Krakow D. Skeletal dysplasias. Clin Perinatol 2015;42(2):301–19. DOI: 10.1016/j.clp.2015.03.003.

26. Kulikova K.S., Tiulpakov A.N. Hypophosphatemic rickets: pathogenesis, diagnosis and treatment. Ozhirenie i metabolizm = Obesity and metabolism 2018;15(2):46–50. (In Russ.). DOI: 10.14341/omet9672

27. Eseonu K.C., Payne K., Ward S. et al. Chronic low back pain occurring in association with hypermobility spectrum disorder and Ehlers–Danlos syndrome. Int J Spine Surg 2021;15(3):449–57. DOI: 10.14444/8067

28. Goode A.P., Cleveland R.J., Schwartz T.A. et al. Relationship of joint hypermobility with low Back pain and lumbar spine osteoarthritis. BMC Musculoskelet Disord 2019;20(1):158. DOI: 10.1186/s12891-019-2523-2

29. Connective tissue dysplasia. Clinical recommendations. Project. The Russian Scientific Medical Society of Therapists (RNMOT). (In Russ.).Available at: https://www.rnmot.ru/public/uploads/ RNMOT/clinical/2019/Клинические%20рекомендации%20 Дисплазии%20соединительной%20ткани%20(проект).pdf

30. Kutsenko V.A., Prodan A.I. Classification of spondylolisthesis N.I. Khvisyuka. Khirurgiya Pozvonochnika = Russian Journal of Spine Surgery 2008;4:072–7. (In Russ.). DOI: 10.14531/ss2008.4.72-77

31. Karademir M., Eser O., Karavelioglu E. Adolescent lumbar disc herniation: Impact, diagnosis, and treatment. J Back Musculoskelet Rehabil 2017;30(2):347–52. DOI: 10.3233/BMR-160572

32. Diamond S., Borenstein D. Chronic low back pain in a working-age adult. Best Pract Res Clin Rheumatol 2006;20(4):707–20. DOI: 10.1016/j.berh.2006.04.002

33. Novikova A.V., Pravdyuk N.G., Saklakova V.S. et al. Degenerative disc disease in the young: cytokine profile and angiogenesis factors. Vestnik Rossijskogo Gosudarstvennogo Medicinskogo Universiteta = Bulletin of the Russian State Medical University 2021; 6:81–9. (In Russ.) DOI: 10.24075/vrgmu.2021.061

34. Shostak N.A., Pravdyuk N.G., Novikova A.V. Back pain in young people: algorithm of management in practice of primary physician. Klinicist = The Clinician 2022;16(3):48–57. (In Russ.). DOI: 10.17650/1818-8338-2022-16-3-К674

35. Pravdyuk N.G., Novikova A.V., Shostak N.A. et al. Immunomorphogenesis in degenerative disc disease: the role of proinflammatory cytokines and angiogenesis factors. Biomedicines 2023;11(8):2184. DOI: 10.3390/biomedicines11082184

36. Devlikamova F.I., Khabirov F.A. Myofascial pain syndrome: practical development of theoretical foundations. Rossijskij zhurnal boli = Russian Journal of Pain 2020;18(3):39–47. (In Russ.) DOI: 10.17116/pain20201803139

37. Setton L.A., Chen J. Cell mechanics and mechanobiology in the intervertebral disc. Spine (Phila Pa 1976) 2004;29(23):2710–23. DOI: 10.1097/01.brs.0000146050.57722.2a

38. Lotz J.C., Colliou O.K., Chin J.R. et al. Compression-induced degeneration of the intervertebral disc: an in vivo mouse model and finite-element study. Spine (Phila Pa 1976) 1998;23(23):2493–506. DOI: 10.1097/00007632-199812010-00004

39. Danilov A.B., Kurganova Yu.M. Ofisnyy sindrom. Russkij medicinskij zhurnal = Russian Medical Journal 2011;30:1902. (In Russ.).

40. Heymans M.W., van Tulder M.W., Esmail R. et al. Back schools for non-specific low-back pain. Cochrane Database Syst Rev 2004;4:CD000261. DOI: 10.1002/14651858.CD000261.pub2

41. Kudryavtseva I.P., Safonova G.D., Berdyugin K.A. The condition of the paravertebral muscles in diseases of the spine. Sovremennye problemy nauki i obrazovaniya = Modern problems of science and education 2015;5:166. (In Russ.)

42. Sergeev A.V. Pain in the lower back: therapy from the perspective of evidence-based medicine and new opportunities. Nevrologiya, nejropsikhiatriya, psikhosomatika = Neurology, neuropsychiatry, psychosomatics 2013;3:78–85. (In Russ.). DOI: 10.14412/2074-2711-2013-2346

43. Krismer M., van Tulder M. Low Back Pain Group of the Bone and Joint Health Strategies for Europe Project. Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract Res Clin Rheumatol 2007;21(1): 77–91. DOI: 10.1016/j.berh.2006.08.004

44. Mishchenko I.A., Chernykh S.V. Special physical exercises to correct muscle imbalance in girls 7–8 years old with asymmetrical posture and scoliosis. Ucheny`e zapiski universiteta im. P.F. Lesgafta = Scientific notes of the P.F. Lesgaft University 2023;1(215):334–8. (In Russ.). DOI: 10.34835/issn.2308-1961.2023.01.p334-338

45. Matishev A.A., Chernukha S.M., Lagoda S.O. Features of the use of special exercises aimed at strengthening the muscles of axial stability and the development of proprioception in young athletes. Fizicheskaya kul’tura, sport – nauka i praktika = Physical education, sports – science and practice 2018;1:94–100. (In Russ.).

46. Roelofs P.D., Deyo R.A., Koes B.W. et al. Non-steroidal antiinflammatory drugs for low back pain. Cochrane Database Syst Rev 2008;1:CD000396. DOI: 10.1002/14651858.CD000396.pub3. Review

47. Karateev A.E., Nasonov E.L., Yakhno N.N. et al. Clinical guidelines «Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice». Sovremennaya revmatologiya = Modern Rheumatology Journal 2015;9(1):4–23. (In Russ.). DOI: 10.14412/1996-7012-2015-1-4-23

48. Alekseev V.V. Diagnostika i lechenie ostrykh poyasnichnykh boley. Consilium Medicum 2009;11(2):42–6. (In Russ.).

49. Erdes Sh.F. Nonspecific pain in the lower back. Clinical recommendations for district therapists and general practitioners. Moscow, 2008. (In Russ.).

50. Kozhakhmetova R.A. Evaluation of the effectiveness of nimesulide in young patients with dorsalgia caused by clinical manifestations of spinal osteochondrosis. Nauka i zdravookhranenie = Science and health 2014;5:73–5. (In Russ.).

51. Karateev A.E. Comparative assessment of the effect of nimesulide on the upper gastrointestinal tract. Lechashchij vrach = Attending doctor 2014;7:51. (In Russ.).

52. Kress H.G., Baltov A., Basiński A. et al. Acute pain: a multifaceted challenge – the role of nimesulide. Curr Med Res Opin 2016;32(1):23–36. DOI: 10.1185/03007995.2015.1100986

53. Castellsague J., Pisa F., Rosolen V. et al. Risk of upper gastrointestinal complications in a cohort of users of nimesulide and other nonsteroidal anti-inflammatory drugs in Friuli Venezia Giulia, Italy. Pharmacoepidemiol Drug Saf 2013;22(4):365–75. DOI: 10.1002/pds.3385

54. Masclee G.M.C., Straatman H., Arfe A. et al. Risk of acute myocardial infarction during use of individual NSAIDs: a nested case-control study from the SOS project. PLoS One 2018;13(11):e0204746. DOI: 10.1371/journal.pone.0204746. eCollection 2018

55. DOI: 10.31550/1727-2378-2019-165-10-38-42 Knorring G.U., Vyortkin, A.L. ‘Correct’ Nimesulide: A Pharmacologist’s Opinion. Doktor.Ru = Doctor.Ru 2019;10(165):38–42. (In Russ.). DOI: 10.31550/1727-2378-2019-165-10-38-42

56. Kudaeva F.M., Barskova V.G., Nasonova V.A. Comparison of speed of anti-inflammatory and analgesic effect appearance of nimesulid and diclofenac sodium tablets in gout arthritis: a randomized study. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice 2008;46(1):55–9. (In Russ.). DOI: 10.14412/1995-4484-2008-854