The review presents differential diagnosis and pathogenetic therapy for back pain (BP). In the treatment of BP associated with spondylosis and spondyloarthrosis, slow-acting symptom-modifying drugs SYSADOA containing chondroitin sulfate remain promising. Extensive experience has been accumulated in the successful use of a biological drug for parenteral administration, Alflutop, for BP. The presented results of observational and placebo-controlled studies give reason to believe that the analgesic and anti-inflammatory effects of Alflutop, applied paravertebrally and/or intramuscularly at a dose of 2.0 ml every other day No. 10 for vertebrogenic lumboischialgia of chronic course, appear already in the 2nd week and increase during 3 months. Alflutop’s early analgesic effect distinguishes it from almost all injectable drugs belonging to the SYSADOA class known in the Russian Federation. During therapy with Alflutop, the need for nonsteroidal anti-inflammatory drugs (NSAIDs) is significantly reduced, and, consequently, the risk of developing threatening gastrointestinal, cardiovascular and renal side effects is decreased. In order to prevent exacerbations, it is advisable to carry out repeated courses of treatment 2–3 times a year.

Keywords: spondyloarthrosis, SYSADOA, alflutop, back pain