clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2022-100-11-12-527-534clinmed-466Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESХроническая скелетно-мышечная боль: патогенез, особенности клиники, возможности терапииChronic musculoskeletal pain: pathogenesis, clinical features, therapy possibilitieshttps://orcid.org/0000-0002-1391-0711КаратеевА. Е.KarateevA. E.

Каратеев Андрей Евгеньевич — д-р мед. наук, начальник отдела воспалительных заболеваний суставов

115522, Москва

Karateev Andrey E.

115522, Moscow

aekarat@yandex.ruФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation20221701202310011-12527534Copyright © Каратеев А.Е., 20232023Каратеев А.Е.Karateev A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/466

Контроль скелетно-мышечной боли (СМБ) — важная часть комплексного лечения ревматических заболеваний (РЗ). Анальгетическая терапия остается ведущим направлением при остеоартрите (ОА) и хронической неспецифической боли в спине (синдрома, который в большинстве случаев связан с ОА позвоночника). Несмотря на активное использование современных базисных противовоспалительных препаратов (включая генно-инженерные биологические препараты и ингибиторы JAK), проблема контроля СМБ остается актуальной при иммуновоспалительных РЗ, таких как ревматоидный артрит и спондилоартриты. Патогенез СМБ носит комплексный характер и тесно связан с процессами повреждения, воспаления и дегенерации. Принципиальную роль здесь играет локальная и системная воспалительная реакция, во многом определяющая такие элементы патогенеза хронической СМБ, как периферическая и центральная сенситизация. В зависимости от преобладающих механизмов патогенеза, СМБ может проявляться несколькими фенотипами — «воспалительным», «механическим», «энтезопатическим», связанным с центральной сенситизацией. Для СМБ характерно сочетание с такими симптомами, как скованность, утомляемость, мышечное напряжение, нарушение сна, депрессия и тревога. Контроль СМБ должен носить комплексный характер и включать использование как медикаментозных, так и немедикаментозных средств. Для лечения боли применяют нестероидные противовоспалительные препараты, опиоиды, миорелаксанты, антидепрессанты и антиконвульсанты, локальную инъекционную терапию (глюкокортикоиды, гиалуроновую кислоту, обогащенную тромбоцитами плазму), а также методы физиотерапии и реабилитации.

The control of musculoskeletal pain (MSP) is an important part of the complex treatment of rheumatic diseases (RD). Analgesic therapy still plays the leading role in osteoarthritis (OA) and chronic nonspecific back pain (most cases of this syndrome are associated with spinal OA) treatment. Despite the use of modern basic anti-inflammatory drugs (including biological and JAK inhibitors), the problem of MSP control remains relevant in immuno-inflammatory diseases, such as rheumatoid arthritis and spondyloarthritis. The pathogenesis of MSP is complex and closely related to the processes of damage, inflammation and degeneration. A fundamental role here belongs to local and systemic inflammatory response occurrence, which largely determines such elements of the pathogenesis of chronic MSP as peripheral and central sensitization. Depending on the prevailing pathogenesis mechanisms, MSP can manifest itself in several phenotypes: «inflammatory», «mechanical», «enthesopathic», associated with central sensitization. A combination with such symptoms as stiffness, fatigue, muscle tension, sleep disturbance, depression and anxiety is characteristic for MSP. The control should be comprehensive and must include the use of both drug and drug-free preparations. Nonsteroidal anti-inflammatory drugs, opioids, muscle relaxants, antidepressants and anticonvulsants, local injection therapy (glucocorticoids, hyaluronic acid, platelet-rich plasma), as well as methods of physiotherapy and rehabilitation are used in pain treatment.

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The authors declare that there are no conflicts of interest present.