The prevalence of lower back pain (LBP) in type 2 diabetes mellitus (DM2) is almost 2 times higher than in the similar control group (by age and gender). The association of DM2 with the severity, chronicity and recurrence of LBP was revealed. DM2 duration correlates with the severity and prevalence of degenerative-dystrophic changes. The representation of concomitant somatic pathology in patients with DM2 is significantly higher than in patients without DM2. Rational selection of the therapy regimen for LBP should be based on comorbid pathology. The molecular mechanisms of synergism of muscle relaxant (tolperizone), nonsteroidal anti-inflammatory drug (NSAID) (meloxicam), and B vitamins as part of complex pharmacotherapy of pain were analyzed. This treatment regimen has a number of benefits: lack of dependence, anti-inflammatory effect, neuroprotective and remyelinating effect, reduction of muscular hypertonus. A number of studies have shown the efficacy of such combination therapy in patients of different age groups with comorbid conditions. It does not require an increase in NSAID doses and significantly reduces the risk of adverse events (AE). The applied treatment regimen is a combination of a muscle relaxant (tolperizone), NSAID (meloxicam) and a complex of B vitamins has already demonstrated its efficacy in the treatment of LBP in patients with comorbid diseases, according to the effect on the inflammatory process indicators (in the absence of AE). KEYWORDS: diabetes mellitus, lower back pain, body mass index, nonsteroidal anti-inflammatory drugs, meloxicam, muscle relaxants, tolperizone, B vitamins. FOR CITATION: Shavlovskaya O.A., Bokova I.A., Shavlovsky N.I., Yukhnovskaya Yu.D. Possibilities of pain syndrome therapy in patients with diabetes mellitus. Russian Medical Inquiry. 2021;5(5):307–315 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-307-315.