Back pain in elderly patients with locomotive syndrome: Focus on efficacy and safety

Back and joint pain occur in 70% of patients aged 60 years and older. The presence of arterial hypertension (AH), cerebrovascular diseases (strokes, heart attacks, chronic heart failure, ischemic heart disease), diabetes mellitus create significant obstacles to the choice of therapy. In 2007, the term “locomotive syndrome” (LS) appeared in world practice, proposed by the Japanese Orthopedic Association to characterize elderly patients with unstable balance, a tendency to fall, due to structural and functional damage to the organs of the nervous and musculoskeletal systems. Chronic musculoskeletal pain in LS has a number of features, such as minor severity (constant nature, exacerbations associated with blood pressure fluctuations). The presence of cognitive impairment complicates the assessment of the severity of pain syndrome, but at the same time triggers a cascade of neuropsychiatric symptoms (anxiety, depressive mood). The problem of treating geriatric patients with LS is a complex task, but knowledge of the basic principles allows you to avoid mistakes in choosing drug therapy and adequately add other non-drug regimens. All patients over 65 years old with chronic pain should be screened for cognitive impairment, anxiety and depression. These syndromes themselves can worsen the patient’s condition and make pain therapy ineffective. Evaluation of the drugs used, especially for pain relief, should be carried out taking into account drug interactions. Compliance with simple rules will help reduce the severity of symptoms, improve functioning and quality of life. Among NSAIDs, preference should be given to the safest ones, having minimal cardiac risks, not causing deterioration in cognitive functions and falling syndrome.