Therapy for acute nonspecific back pain: new additional opportunities
Abstract
Information about a favorable prognosis for a patient, recommendations for activities, and optimal pharmacotherapy are a mainstay in the effective treatment of acute nonspecific low back pain (NLBP). Standard pharmacotherapy for acute NLBP includes nonsteroidal anti-inflammatory drugs (NSAIDs). However, the longer their administration and larger doses, the higher the risk of side effects are. NSAIDs are contraindicated in some cases. In this connection, it has become necessary to search for new opportunities for the pharmacotherapy of acute NLBP. The results of experimental studies have demonstrated the analgesic and anti-inflammatory effects of high-dose B vitamins. Clinical trials have confirmed the efficacy of vitamin B complex (thiamine, pyridoxine, and cyanocobalamin) in the treatment of acute NLBP. The paper considers the practical significance of concomitant administration of B vitamins and NSAIDs in NLBP and notes the efficacy of milgamma used both alone and in combination with NSAIDs in the treatment of acute NLBP.
About the Authors
V. A. GolovachevaRussian Federation
Veronika Aleksandrovna Golovacheva - Department of Nervous System Diseases and Neurosurgery, Faculty of General Medicine.
11, Rossolimo St., Build. 1, Moscow 119021
A. A. Golovacheva
Russian Federation
Department of Nervous System Diseases and Neurosurgery, Faculty of General Medicine.
11, Rossolimo St., Build. 1, Moscow 119021
References
1. Manek NJ, MacGregor AJ. Epidemiology of back disorders: prevalence, risk factors, and prognosis. Curr Opin Rheumatol. 2005 Mar; 17(2):134-40.
2. Patrick N, Emanski E, Knaub MA. Acute and Chronic Low Back Pain. Med Clin North Am. 2014 Jul;98(4):777-89, xii. doi: 10.1016/j.mcna.2014.03.005.
3. Breivik H, Collett B, Ventafridda V, et al. Survey of Chronic Pain in Europe: Prevalence, Impact on Daily Life, and Treatment. Eur J Pain. 2006 May;10(4):287-333. Epub 2005 Aug 10.
4. Froud R, Patterson S, Eldridge S, et al. A Systematic Review and Meta-Synthesis of the Impact of Low Back Pain on People’s Lives. BMC Musculoskelet Disord. 2014 Feb 21;15:50. doi: 10.1186/1471-2474-15-50.
5. Blyth FM, Briggs AM, Schneider CH, Hoy DG, March LM. The Global Burden of Musculoskeletal Pain-Where to From Here? Am J Public Health. 2018 Nov 29:e1-e6. doi: 10.2105/AJPH.2018.304747. [Epub ahead of print]
6. Wong J, Cote P, Sutton DA, et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2017 Feb;21(2):201-216. doi: 10.1002/ejp.931. Epub 2016 Oct 6.
7. Low Back Pain and Sciatica in Over 16s: Assessment and Management. Clinical Guidelines. London: National Institute for Health and Care Excellence (UK); 2016.
8. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018 Jan;27(1):60-75. doi: 10.1007/s00586-017-5099-2. Epub 2017 Apr 20.
9. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4; 166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14.
10. Parfenov 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. (In Russ.). doi: 10.14412/2074-2711-2018-2-4-11
11. Parfenov VA, Gerasimova ON. Clinical experience of outpatient management of patients with back pain. Consilium Medicum. 2013;(1):5-7. (In Russ.).
12. Koes BW, Van Tulder M, Lin CW, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010 Dec;19(12): 2075-94. doi: 10.1007/s00586-010-1502-y. Epub 2010 Jul 3.
13. Van Tulder MW, Touray T, Furlan AD, et al. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003;(2): CD004252.
14. Pareek A, Chandurkar N, Chandanwale AS, et al. Aceclofenac-tizanidine in the treatment of acute low back pain: a double-blind, doubledummy, randomized, multicentric, comparative study against aceclofenac alone. Eur Spine J. 2009 Dec;18(12):1836-42. doi: 10.1007/s00586-009-1019-4. Epub 2009 May 7.
15. Friedman BW, Dym AA, Davitt M, et al. Naproxen with cyclobenzaprine, oxycodone/ acetamino- phen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA. 2015 Oct 20;314(15):1572-80. doi: 10.1001/jama.2015.13043.
16. Parfenov VA, Gerasimova ON. Causes, diagnosis and treatment of nonspecific lumbalgia: myths and reality. Meditsinskii sovet. 2017;(10):54-8. (In Russ.).
17. Khabirov FA. Rukovodstvo po klinicheskoi nevrologii pozvonochnika [Manual of clinical neurology of the spine]. Kazan': Meditsina; 2006. 520 p.
18. Khabirov FA, Khabirova YuF. Bol' v shee i spine: rukovodstvo dlya vrachei [Neck and back pain: a guide for doctors]. Kazan': Meditsina; 2014. 504 p.
19. Williams CM, Maher CG, Latimer J, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014 Nov 1;384(9954):1586-96. doi: 10.1016/S0140-6736(14)60805-9. Epub 2014 Jul 23.
20. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015 Mar 31; 350:h1225. doi: 10.1136/bmj.h1225
21. Karateev AE. The Russian experience of use of nimesulide: an overview of clinical trials. Consilium Medicum. 2011;13(9):89-95. (In Russ.).
22. Kamchatnov PR. Improving the efficiency and safety of treatment of patients with lumbar pain. Zhurnal nevrologii ipsikhiatrii im. S.S. Korsakova. 2016;116(10): 28-33. (In Russ.).
23. Woelk H, Lehrl S, Bitsch R, Kopcke W. Benfotiamine in treatment of alcoholic polyneuropathy: an 8-week randomized controlled study (BAP I Study). Alcohol Alcohol. 1998 Nov-Dec;33(6):631-8.
24. Emelyanova AYu, Zinov'eva OE. Pathogenesis and Treatment of Polyneuropathy: the Role of Vitamins B. Effektivnayafarmakoterapiya. 2015;(40):42-8. (In Russ.).
25. Briani C, Dalla Torre C, Citton V, et al. Cobalamin deficiency: clinical picture and radiological findings. Nutrients. 2013 Nov 15;5(11):4521-39. doi: 10.3390/nu5114521.
26. Golovacheva VA, Parfenov VA. Modern tactics of management of patients with diabetic polyneuropathy. Farmateka. 2016;(5): 30-7. (In Russ.).
27. Parfenov VA, Golovacheva VA, Fadeev VV, et al. Optimization of management of patients with diabetic polyneuropathy using an interdisciplinary approach. Meditsinskii sovet. 2017;(1): 71-9. (In Russ.).
28. 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.pub3.
29. Jayabalan B, Low LL. Vitamin B supplementation for diabetic peripheral neuropathy. Singapore Med J. 2016 Feb;57(2):55-9. doi: 10.11622/smedj.2016027.
30. Nardone R, Ho ller Y, Storti M, et al. Thiamine Deficiency Induced Neurochemical, Neuroanatomical, and Neuropsychological Alterations: A Reappraisal. Scientific World Journal. 2013 Oct 21;2013:309143. doi: 10.1155/2013/309143.eCollection 2013.
31. Scott J, Molloy A. The discovery of vitamin B (12). Ann NutrMetab. 2012;61(3):239-45. doi: 10.1159/000343114. Epub 2012 Nov 26.
32. Mooney S, Leuendorf JE, Hendrickson C, et al. Vitamin B6: a long known compound of surprising complexity. Molecules. 2009 Jan 12; 14(1):329-51. doi: 10.3390/molecules14010329.
33. Rabzar G, Mardia V, Ra tsep I, et al. Effect of vitamin B(6) vitamers on platelet aggregation. Platelets. 2009 Mar;20(2):120-4. doi: 10.1080/09537100802687674.
34. Zhuravleva MV, Shikh EV, Makhova LA. Connection of analgesic and neurotropic effects on the example of milgamma. Terapevticheskii arkhiv. 2012;84(12):131-4. (In Russ.).
35. 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.
36. Amir J, Ginat S, Cohen YH, Marcus TE, Keller N, Varsano I. Lidocaine as a diluent for administration of benzathine penicillin G. Pediatr Infect Dis J. 1998;17(10):890-893.
37. Danilov AB. Treatment of acute back pain: B-vitamins or NSAIDs? Russkii meditsinskii zhurnal. 2010;(0):35-40. (In Russ.).
38. Lemoine A, Le Devehat C. Clinical conditions requiring elevated dosages of vitamins. Int J Vitam Nutr Res Suppl. 1989;30:129-47.
39. Bartoszyk GD, Wild A. B-vitamins potentiate the antinociceptive effect of diclofenac in car- rageenin-induced hyperalgesia in the rat tail pressure test. Neurosci Lett. 1989 Jun 5; 101(1):95-100.
40. Reyes-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 Pharmacol Toxicol Methods. 1999 Oct;42(2): 73-7.
41. Franca DS, Souza AL, Almeida KR, et al. B vitamins induce an antinoceceptive effect in the acetic acid and formaldehyde models of nociception in mice. Eur J Pharmacol. 2001 Jun 15;421(3):157-64.
42. Sanchez-Ramirez GM, Caram-Salas NL, Rocha-Gonzales HI, et al. Benfotiamine relieves inflamatory and neuropathic pain in rats. Eur J Pharmacol. 2006 Jan 13;530(1-2): 48-53. Epub 2005 Dec 15.
43. Moallem SA, Hosseeinzaden 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.
44. Bartoszyk GD. The interactions of vitamins B1, B6 and B12 with non-steroidal antirheumatic and analgesic drugs: animal experiment results. Klin Wochenschr. 1990 Jan 19;68(2):121-4.
45. Jurna I, Carlsson KH, Komen W, Bonke D. Acute effects of vitamin B6 and fixed combinations of vitamin B1, B6 and B12 on nociceptive activity evoked in the rat thalamus: dose-response relationship and combinations with morphine and paracetamol. Klin Wochenschr. 1990 Jan 19;68(2):129-35.
46. Vetter G, Bru ggemann G, Lettko M, et al. Verku rzung der Diclofenac-therapie durch B-vitamine. Ergebnisse einer randomisierten dopplelblinstudie, Diclofenac 50 mg gegen Diclofenac 50 mg plus B-vitamine, bei schmerzhaften wirbelsa ulenerkrankungen mit degenerativen Vera nderungen. ZRheumatol. 1988 Sep-Oct;47(5):351-62.
47. Kuhlwein A, Meyer HJ, Koehler CO. Reduced need for diclofenac with concomitant B-vitamin therapy: Results of a double-blind clinical study with re- duced diclofenac-dosage (75 mg diclofenac vs. 75 mg diclofenac plus B-vitamins daily) in pa- tients with acute lumbago. Klin Wochenschr. 1990 Jan 19;68(2):107-15.
48. Bruggemann G, Koehler CO, Koch EM. Ergebnisse einer Doppelblindpriifung Diclofenac + Vitamin B1, B6, B12 versus Diclofenac bei Patienten mit akuten Beschwerden im Lendenwirbelsaulenbereich. Klin Wochenschr. 1990 Jan 19;68(2):116-20.
49. Koch EM, Ehrhardt A. Der Beitrag von B-Vitaminen in der Therapia von Wirbelsaulen-syndromen. In: Rietbrock N, editor. Pharmako-logie und klinische Anwendung hochdosierter B-vitamine. Darmstadt: Steinkopff Verlag; 1991.
50. Lettko M. Ergebnisse einer Doppelblind-studie, Diclofenac und B-vitamine gegen Diclofenac, zur Priifung der additiven Wirksamkeit der B-Vitamine. Rheuma, Schmerz & Entzun-dung. 1986;(8):22-30
51. Mibielli 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.
Review
For citations:
Golovacheva V.A., Golovacheva A.A. Therapy for acute nonspecific back pain: new additional opportunities. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(4):123-128. (In Russ.) https://doi.org/10.14412/2074-2711-2018-4-123-128