nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2021-5-102-108nnp-1673Research ArticleREVIEWSОБЗОРЫAdjunctive therapy for acute musculoskeletal painДополнительная терапия при острой скелетно-мышечной болиГоловачеваВ. А.GolovachevaV. A.

Вероника Александровна Головачева

Кафедра нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского

119021, Москва, ул. Россолимо, 11, стр. 1

Veronika Aleksandrovna Golovacheva

Department of Nervous System Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine

11, Rossolimo St., Build. 1, Moscow 119021

xoxo.veronicka@gmail.comГоловачеваА. А.GolovachevaA. A.

Кафедра нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского

119021, Москва, ул. Россолимо, 11, стр. 1

Department of Nervous System Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine

11, Rossolimo St., Build. 1, Moscow 119021

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский Университет) Минздрава РоссииРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of RussiaRussian Federation202116102021135102108Copyright © Golovacheva V.A., Golovacheva A.A., 20212021Головачева В.А., Головачева А.А.Golovacheva V.A., Golovacheva A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/1673

Acute musculoskeletal pain (MSP) is one of the leading complaints at patients' admission. Acute MSP is usually localized in the lower back, neck, shoulder girdles, and shins. With an increase in the number of obese and hypodynamic people, the prevalence of MSP increases, especially lower back pain. Treatment of acute MSP in the back consists of informing the patient about a favorable prognosis of the disease, recommendations to maintain daily activity, primary and additional pharmacotherapy. Primary or main pharmacotherapy of acute MSP in the back includes non-steroidal anti-inflammatory drugs (NSAIDs). Adjunctive therapy is usually used in combination with NSAIDs and is aimed to increase the effectiveness of treatment and reduce the duration of NSAIDs use. As an additional therapy, muscle relaxants or B vitamins can be prescribed. The efficacy and safety of combination therapy of NSAIDs and high-dose complexes of B vitamins have been demonstrated in clinical trials involving patients with acute back pain.

Острая скелетно-мышечная боль (СМБ) – одна из ведущих жалоб при обращении к врачу. По локализации острая СМБ наиболее часто встречается в области нижней части спины, в шее, надплечьях и голенях. С увеличением числа людей с ожирением и гиподинамией повышается распространенность СМБ, особенно в нижней части спины. Лечение острой СМБ в спине состоит из информирования пациента о благоприятном прогнозе заболевания, рекомендации поддерживать повседневную активность, базовой и дополнительной фармакотерапии. К средствам базовой, или основной, фармакотерапии острой СМБ в спине относятся средства из группы нестероидных противовоспалительных препаратов (НПВП). Дополнительная терапия применяется обычно совместно с НПВП и направлена на повышение эффективности лечения и сокращение продолжительности приема НПВП. В качестве дополнительной терапии могут назначаться миорелаксанты или витамины группы В. Эффективность и безопасность комбинированной терапии НПВП и высокодозных комплексов витаминов группы В продемонстрированы в клинических исследованиях, включавших пациентов с острой болью в спине.

скелетно-мышечная больострая боль в спинедополнительная терапиялечениевитамины группы Вmusculoskeletal painacute back painadjunctive therapytreatmentB vitaminsСтатья спонсируется компанией ООО «Верваг Фарма».This article has been supported by LLC «Woerwag Pharma».ReferencesHawker GA. The assessment of musculoskeletal pain. Clin Exp Rheumatol. 2017 SepOct;35 Suppl 107(5):8-12. Epub 2017 Sep 28.Hawker GA. The assessment of musculoskeletal pain. Clin Exp Rheumatol. 2017 SepOct;35 Suppl 107(5):8-12. Epub 2017 Sep 28.Arendt-Nielsen L, Fernandez-de-Las-Penas C, Graven-Nielsen T. Basic aspects of musculoskeletal pain: from acute to chronic pain. J Man Manip Ther. 2011 Nov;19(4):186-93. doi: 10.1179/106698111X13129729551903Arendt-Nielsen L, Fernandez-de-Las-Penas C, Graven-Nielsen T. Basic aspects of musculoskeletal pain: from acute to chronic pain. J Man Manip Ther. 2011 Nov;19(4):186-93. doi: 10.1179/106698111X13129729551903Devereaux M. Low back pain. Med Clin North Am. 2009 Mar;93(2):477-501, x. doi: 10.1016/j.mcna.2008.09.013Devereaux M. Low back pain. Med Clin North Am. 2009 Mar;93(2):477-501, x. doi: 10.1016/j.mcna.2008.09.013Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-91. doi: 10.7326/0003-4819-147-7-200710020-00006Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-91. doi: 10.7326/0003-4819-147-7-200710020-00006Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11):2791-803. doi: 10.1007/s00586-018-5673-2. Epub 2018 Jul 3.Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11):2791-803. doi: 10.1007/s00586-018-5673-2. Epub 2018 Jul 3.Парфенов ВА, Яхно НН, Кукушкин МЛ и др. Острая неспецифическая (скелетномышечная) поясничная боль. Рекомендации Российского общества по изучению боли (РОИБ). Неврология, нейропсихиатрия, психосоматика. 2018;10(2):4-11. doi: 10.14412/2074-2711-2018-2-4-11Parfenov VA, Yakhno NN, Kukushkin ML, et al. Acute nonspecific (musculoskeletal) low back pain Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2018;10(2):4-11. doi: 10.14412/2074-2711-2018-2-4-11 (In Russ.).Caldwell B, Aldington S, Weatherall M, et al. Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis. J R Soc Med. 2006 Mar;99(3):132-40. doi: 10.1258/jrsm.99.3.132Caldwell B, Aldington S, Weatherall M, et al. Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis. J R Soc Med. 2006 Mar;99(3):132-40. doi: 10.1258/jrsm.99.3.132McGettigan P, Henry D. Use of nonsteroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries. PLoS Med. 2013;10(2):e1001388. doi: 10.1371/journal.pmed.1001388. Epub 2013 Feb 12.McGettigan P, Henry D. Use of nonsteroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries. PLoS Med. 2013;10(2):e1001388. doi: 10.1371/journal.pmed.1001388. Epub 2013 Feb 12.Lapi F, Azoulay L, Yin H, et al. Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with nonsteroidal anti-inflammatory drugs and risk of acute kidney injury: Nested case-control study. BMJ. 2013 Jan 8;346:e8525. doi: 10.1136/bmj.e8525Lapi F, Azoulay L, Yin H, et al. Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with nonsteroidal anti-inflammatory drugs and risk of acute kidney injury: Nested case-control study. BMJ. 2013 Jan 8;346:e8525. doi: 10.1136/bmj.e8525Камчатнов ПР, Умарова ХЯ. Поясничная боль – повышение эффективности терапии. Клиницист. 2013;7(1):64-9. doi: 10.17650/1818-8338-2013-1-64-69Kamchatnov PR, Umarova KhYa. Low back pain – increasing the effectiveness of therapy. Klinitsist. 2013;7(1):64-9. doi: 10.17650/1818-8338-2013-1-64-69 (In Russ.).Данилов АБ. Лечение острой боли в спине: витамины группы «В» или НПВП? Русский медицинский журнал. 2010;(0):35-40. Доступно по ссылке: https://www.rmj.ru/articles/bolevoy_sindrom/Lechenie_ostroy_boli_v_spine_vitaminy_gruppy_V_ili_NPVP/Danilov AB. Treatment of acute back pain: B vitamins or NSAIDs? Russkiy meditsinskiy zhurnal. 2010;(0):35-40. Available from: https://www.rmj.ru/articles/bolevoy_sindrom/Lechenie_ostroy_boli_v_spine_vitaminy_gruppy_V_ili_NPVP/ (In Russ.).Головачева ВА, Головачева АА, Зиновьева ОЕ, Голубев ВЛ. Толперизон в лечении острой и хронической неспецифической боли в спине. Неврология, нейропсихиатрия, психосоматика. 2020;12(4):137-42. doi: 10.14412/2074-2711-2020-4-137-142Golovacheva VA, Golovacheva AA, Zinovyeva OE, Golubev VL. Tolperisone in the treatment of acute and chronic nonspecific back pain. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):137-42. doi: 10.14412/2074-2711-2020-4-137-142 (In Russ.).Van Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003;2003(2):CD004252. doi: 10.1002/14651858.CD004252Van Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003;2003(2):CD004252. doi: 10.1002/14651858.CD004252Чиба Л, Жусупова АС, Лихачев СА и др. Систематический обзор по применению миорелаксантов при боли в нижней части спины. Журнал неврологии и психиатрии им. С.С. Корсакова. 2018;118(12):100-13. doi: 10.17116/jnevro2018118121100Csiba L, Zhussupova AS, Likhachev SA, et al. A systematic review of using myorelaxants in treatment of low back pain. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2018;118(12):100-13. doi: 10.17116/jnevro2018118121100 (In Russ.).Парфенов ВА, Кукушкин МЛ, Давыдов ОС и др. Совет экспертов, посвященный обсуждению ведения пациентов с острой неспецифической болью в спине и применению высокодозных нейротропных комплексов витаминов группы В в качестве ко-анальгетика. Российский журнал боли. 2019;17(3):58-60. doi: 10.25731/RASP.2019.03.34Parfenov VA, Kukushkin ML, Davydov OS, et al. Expert Council dedicated to the discussion of the management of patients with acute nonspecific back pain and the use of high-dose neurotropic complexes of B vitamins as a co-analgesic. Rossiyskiy zhurnal boli. 2019;17(3):58-60. doi: 10.25731/RASP.2019.03.34 (In Russ.).Calderon-Ospina C-A, Nava-Mesa MO, Arbelaez Ariza CE. Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain Management: Systematic Review and Meta-analysis. Pain Med. 2020 Apr 1;21(4):766-81. doi: 10.1093/pm/pnz216Calderon-Ospina C-A, Nava-Mesa MO, Arbelaez Ariza CE. Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain Management: Systematic Review and Meta-analysis. Pain Med. 2020 Apr 1;21(4):766-81. doi: 10.1093/pm/pnz216Журавлева МВ, Ших ЕВ, Махова ЛА. Связь анальгетического и нейротропного эффектов на примере мильгаммы. Терапевтический архив. 2012;84(12):131-4. Доступно по ссылке: https://ter-arkhiv.ru/0040-3660/article/view/31181Zhuravleva MV, Shikh EV, Makhova AA. A relationship between analgesic and neurotropic effects by the example of milgamma. Terapevticheskii arkhiv. 2012;84(12):131-4. Available from: https://ter-arkhiv.ru/0040-3660/article/view/31181 (In Russ.).Simeonov S, Pavlova M, Mitkov M, et al. Therapeutic efficacy of «Milgamma» in patients with painful diabetic neuropathy. Folia Med (Plovdiv). 1997;39(4):5-10.Simeonov S, Pavlova M, Mitkov M, et al. Therapeutic efficacy of «Milgamma» in patients with painful diabetic neuropathy. Folia Med (Plovdiv). 1997;39(4):5-10.Удовиченко ОВ, Курцева ТГ. Эффективность препарата Мильгамма в лечении болевого синдрома и трофических язв при диабетической полинейропатии (предварительное исследование). Сахарный диабет. 1999;2(2):32-4. doi: 10.14341/2072-0351-6147Udovichenko OV, Kurtseva TG. The effectiveness of the drug Milgamma in the treatment of pain syndrome and trophic ulcers in diabetic polyneuropathy (preliminary study). Sakharnyy diabet. 1999;2(2):32-4. doi: 10.14341/2072-0351-6147 (In Russ.).Головачева ВА, Парфенов ВА. Лечение острой неспецифической пояснично-крестцовой боли: современные рекомендации и новые подходы в фармакотерапии. Медицинский Совет. 2019;(18):34-41. doi: 10.21518/2079-701X-2019-18-34-41Golovacheva VA, Parfenov VA. Management of acute nonspecific lumbosacral pain: modern guidelines and new approaches in pharmacotherapy. Meditsinskiy sovet = Medical Council. 2019;(18):34-41. doi: 10.21518/2079-701X-2019-18-34-41 (In Russ.).Ang CD, Alviar MJ, Dans AL, et al. Vitamin B for treating peripheral neuropathy. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD004573. doi: 10.1002/14651858.CD004573.pub3Ang CD, Alviar MJ, Dans AL, et al. Vitamin B for treating peripheral neuropathy. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD004573. doi: 10.1002/14651858.CD004573.pub3Парфенов ВА, Головачева ВА, Фадеев ВВ и др. Оптимизация ведения пациентов с диабетической полиневропатией с помощью междисциплинарного подхода. Медицинский Совет. 2017;(1S):71-9. doi: 10.21518/2079-701X-2017-0-71-79Parfenov VA, Golovacheva VA, Fadeev VV, et al. Optimization diabetic polyneuropathy patients management using a multidisciplinary approach. Meditsinskiy sovet = Medical Council. 2017;(1S):71-9. doi: 10.21518/2079-701X-2017-0-71-79 (In Russ.).Емельянова АЮ, Зиновьева ОЕ. Патогенез и лечение полиневропатий: роль витаминов группы В. Эффективная фармакотерапия. 2015;40:42-8. Доступно по ссылке: https://umedp.ru/articles/patogenez_i_lechenie_polinevropatiy_rol_vitaminov_gruppy_v_.htmlYemel'yanova AYu, Zinov'yeva OYe. Pathogenesis and treatment of polyneuropathies: the role of B vitamins. Effektivnaya farmakoterapiya. 2015;40:42-8. Available from: https://umedp.ru/articles/patogenez_i_lechenie_polinevropatiy_rol_vitaminov_gruppy_v_.html (In Russ.).Камчатнов ПР. Повышение эффективности и безопасности лечения пациентов с поясничной болью. Журнал неврологии и психиатрии им. С.С. Корсакова. 2016;116(10):28-33. doi: 10.17116/jnevro201611610128-33Kamchatnov PR. Improving the effectiveness and safety of the treatment of patients with low back pain. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2016;116(10):28-33. doi: 10.17116/jnevro201611610128-33 (In Russ.).Torres A, Gutierrez R. Analgesic Effect of B Vitamins, 50 Years after the First Fixed Combination of Thiamine, Pyridoxine and Cyanocobalamin. Med Int Mex. 2012;28(5):473-82. Available from: https://www.medigraphic.com/cgibin/new/resumenI.cgi?IDARTICULO=37302Torres A, Gutierrez R. Analgesic Effect of B Vitamins, 50 Years after the First Fixed Combination of Thiamine, Pyridoxine and Cyanocobalamin. Med Int Mex. 2012;28(5):473-82. Available from: https://www.medigraphic.com/cgibin/new/resumenI.cgi?IDARTICULO=37302Lemoine A, Le Devehat C. Clinical conditions requiring elevated dosages of vitamins. Int J Vitam Nutr Res Suppl. 1989;30:129-47.Lemoine A, Le Devehat C. Clinical conditions requiring elevated dosages of vitamins. Int J Vitam Nutr Res Suppl. 1989;30:129-47.Franca DS, Souza AL, Almeida KR, et al. B vitamins induce an antinociceptive effect in the acetic acid and formaldehyde models of nociception in mice. Eur J Pharmacol. 2001 Jun 15;421(3):157-64. doi: 10.1016/s0014-2999(01)01038-xFranca DS, Souza AL, Almeida KR, et al. B vitamins induce an antinociceptive effect in the acetic acid and formaldehyde models of nociception in mice. Eur J Pharmacol. 2001 Jun 15;421(3):157-64. doi: 10.1016/s0014-2999(01)01038-xSanchez-Ramirez GM, Caram-Salas NL, Rocha-Gonzalez HI, et al. Benfotiamine relieves inflammatory and neuropathic pain in rats. Eur J Pharmacol. 2006 Jan 13;530(1-2):48-53. doi: 10.1016/j.ejphar.2005.11.016. Epub 2005 Dec 15.Sanchez-Ramirez GM, Caram-Salas NL, Rocha-Gonzalez HI, et al. Benfotiamine relieves inflammatory and neuropathic pain in rats. Eur J Pharmacol. 2006 Jan 13;530(1-2):48-53. doi: 10.1016/j.ejphar.2005.11.016. Epub 2005 Dec 15.Moallem SA, Hosseinzadeh H, Farahi S. A study of acute and chronic anti-nociceptive and anti-inflammatory effects of thiamine in mice. Iran Biomed J. 2008 Jul;12(3):173-8. Available from: https://pubmed.ncbi.nlm.nih.gov/18762821/Moallem SA, Hosseinzadeh H, Farahi S. A study of acute and chronic anti-nociceptive and anti-inflammatory effects of thiamine in mice. Iran Biomed J. 2008 Jul;12(3):173-8. Available from: https://pubmed.ncbi.nlm.nih.gov/18762821/Bartoszyk GD. Zur Wechselwirkung der Vitamine B1 , B 6 und B 12 mitnichtsteroidalen Antirheumatika und Analgetika: Tierexperimentelle Befunde [The interactions of vitamins B1 , B 6 and B 12 with non-steroidal antirheumatic and analgesic drugs: animal experiment results]. Klin Wochenschr. 1990 Jan 19;68(2):121-4. doi: 10.1007/BF01646859 (In Germ.).Bartoszyk GD. Zur Wechselwirkung der Vitamine B1 , B 6 und B 12 mitnichtsteroidalen Antirheumatika und Analgetika: Tierexperimentelle Befunde [The interactions of vitamins B1 , B 6 and B 12 with non-steroidal antirheumatic and analgesic drugs: animal experiment results]. Klin Wochenschr. 1990 Jan 19;68(2):121-4. doi: 10.1007/BF01646859 (In Germ.).Jurna I, Carlsson KH, Komen W, Bonke D. Acute effects of vitamin B6 and fixed combinations of vitamin B1 , B 6 and B 12 on nociceptive activity evoked in the rat thalamus: doseresponse relationship and combinations with morphine and paracetamol. Klin Wochenschr. 1990 Jan 19;68(2):129-35. doi: 10.1007/BF01646861Jurna I, Carlsson KH, Komen W, Bonke D. Acute effects of vitamin B6 and fixed combinations of vitamin B1 , B 6 and B 12 on nociceptive activity evoked in the rat thalamus: doseresponse relationship and combinations with morphine and paracetamol. Klin Wochenschr. 1990 Jan 19;68(2):129-35. doi: 10.1007/BF01646861Vetter G, Brüggemann G, Lettko M, et al. Verkürzung der Diclofenac-Therapie durch B-Vitamine. Ergebnisse einer randomisierten Doppelblindstudie, Diclofenac 50 mg gegen Diclofenac 50 mg mit degenerativen Veränderungen [Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes]. Z Rheumatol. 1988 Sep-Oct;47(5):351-62 (In Germ.).Vetter G, Brüggemann G, Lettko M, et al. Verkürzung der Diclofenac-Therapie durch B-Vitamine. Ergebnisse einer randomisierten Doppelblindstudie, Diclofenac 50 mg gegen Diclofenac 50 mg mit degenerativen Veränderungen [Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes]. Z Rheumatol. 1988 Sep-Oct;47(5):351-62 (In Germ.).Deng XT, Han Y, Liu WT, Song XJ. B Vitamins Potentiate Acute Morphine Antinociception and Attenuate the Development of Tolerance to Chronic Morphine in Mice. Pain Med. 2017 Oct 1;18(10):1961-74. doi: 10.1093/pm/pnw358Deng XT, Han Y, Liu WT, Song XJ. B Vitamins Potentiate Acute Morphine Antinociception and Attenuate the Development of Tolerance to Chronic Morphine in Mice. Pain Med. 2017 Oct 1;18(10):1961-74. doi: 10.1093/pm/pnw358Левин ОС, Мосейкин ИА. Комплекс витаминов группы В (мильгамма) в лечении дискогенной пояснично-крестцовой радикулопатии. Журнал неврологии и психиатрии им. С.С. Корсакова. 2009;109(10):30-5.Levin OS, Moseikin IA. Vitamin B complex (milgamma) in the treatment of vertebrogenic lumbosacral radiculopathy. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2009;109(10):30-5 (In Russ.).Bartoszyk GD, Wild A. B-vitamins potentiate the antinociceptive effect of diclofenac in carrageenin-induced hyperalgesia in the rat tail pressure test. Neurosci Lett. 1989 Jun 5;101(1):95-100. doi: 10.1016/0304-3940(89)90447-3Bartoszyk GD, Wild A. B-vitamins potentiate the antinociceptive effect of diclofenac in carrageenin-induced hyperalgesia in the rat tail pressure test. Neurosci Lett. 1989 Jun 5;101(1):95-100. doi: 10.1016/0304-3940(89)90447-3Reyes-Garcia G, Medina-Santillan R, Teran-Rosales F, et al. Characterization of the potentiation of the antinociceptive effect of diclofenac by vitamin B complex in the rat. J PharmacolToxicol Methods. 1999 Oct;42(2):73-7. doi: 10.1016/s1056-8719(00)00045-9Reyes-Garcia G, Medina-Santillan R, Teran-Rosales F, et al. Characterization of the potentiation of the antinociceptive effect of diclofenac by vitamin B complex in the rat. J PharmacolToxicol Methods. 1999 Oct;42(2):73-7. doi: 10.1016/s1056-8719(00)00045-9Kuhlwein A, Meyer HJ, Koehler CO. Einsparung von Diclofenac durch B-Vitamine: Ergebnisse einer randomisierten Doppelblindprüfung mit reduzierten Tagesdosierungen von Diclofenac (75 mg Diclofenac versus 75 mg Diclofenac plus B-Vitamine) bei akuten Lendenwirbelsäulensyndromen [Reduced diclofenac administration by B vitamins: results of a randomized double-blind study with reduced daily doses of diclofenac (75 mg diclofenac versus 75 mg diclofenac plus B vitamins) in acute lumbar vertebral syndromes]. Klin Wochenschr. 1990 Jan 19;68(2):107-15. doi: 10.1007/BF01646857 (In Germ.)].Kuhlwein A, Meyer HJ, Koehler CO. Einsparung von Diclofenac durch B-Vitamine: Ergebnisse einer randomisierten Doppelblindprüfung mit reduzierten Tagesdosierungen von Diclofenac (75 mg Diclofenac versus 75 mg Diclofenac plus B-Vitamine) bei akuten Lendenwirbelsäulensyndromen [Reduced diclofenac administration by B vitamins: results of a randomized double-blind study with reduced daily doses of diclofenac (75 mg diclofenac versus 75 mg diclofenac plus B vitamins) in acute lumbar vertebral syndromes]. Klin Wochenschr. 1990 Jan 19;68(2):107-15. doi: 10.1007/BF01646857 (In Germ.)].Brüggemann G, Koehler CO, Koch EM. Ergebnisse einer Doppelblindprüfung Diclofenac + Vitamin B1 , B6 , B 12 versus Diclofenac bei Patienten mit akuten Beschwerden im Lendenwirbelsäulenbereich. Eine Multicenterstudie [Results of a double-blind study of diclofenac + vitamin B1 , B6 , B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study]. Klin Wochenschr. 1990 Jan 19;68(2):116-20. doi: 10.1007/BF01646858 (In Germ.)].Brüggemann G, Koehler CO, Koch EM. Ergebnisse einer Doppelblindprüfung Diclofenac + Vitamin B1 , B6 , B 12 versus Diclofenac bei Patienten mit akuten Beschwerden im Lendenwirbelsäulenbereich. Eine Multicenterstudie [Results of a double-blind study of diclofenac + vitamin B1 , B6 , B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study]. Klin Wochenschr. 1990 Jan 19;68(2):116-20. doi: 10.1007/BF01646858 (In Germ.)].Lettko M. Ergebnisse einer Doppelblindstudie, Diclofenac und B-vitamine gegen Diclofenac, zur Priifung der additiven Wirksamkeit der B-Vitamine. Rheum Schmerz Entzundung. 1986;(8):22-30 Available from: https://www.scirp.org/(S(vtj3fa45qm1ean45vvffcz55))/reference/ReferencesPapers.aspx?ReferenceID=1674395Lettko M. Ergebnisse einer Doppelblindstudie, Diclofenac und B-vitamine gegen Diclofenac, zur Priifung der additiven Wirksamkeit der B-Vitamine. Rheum Schmerz Entzundung. 1986;(8):22-30 Available from: https://www.scirp.org/(S(vtj3fa45qm1ean45vvffcz55))/reference/ReferencesPapers.aspx?ReferenceID=1674395Mibielli MA, Geller M, Cohen JC, et al. Diclofenac Plus B Vitamins Versus Diclofenac Monotherapy in Lumbago: the DOLOR Study. Curr Med Res Opin. 2009 Nov;25(11):2589-99. doi: 10.3111/13696990903246911Mibielli MA, Geller M, Cohen JC, et al. Diclofenac Plus B Vitamins Versus Diclofenac Monotherapy in Lumbago: the DOLOR Study. Curr Med Res Opin. 2009 Nov;25(11):2589-99. doi: 10.3111/13696990903246911

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