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Experience with chondroitin sulfate in the combination therapy of lower back pain

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Standard treatment for lower back pain (LBP) includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Objective: to determine the magnitude of the effect of injectable chondroitin sulfate (CS) as part of combination therapy for LBP on the intensity of pain syndrome.

Patients and methods. The investigation was conducted in August 2019 to February 2020. A total of 60 patients (23 men and 37 women) aged 36 to 66 years (mean age, 48.65±8.72 years) with non-specific LBP were followed up. The patients were divided into two equal groups. A study group (n=30) took a NSAID (meloxicam) 7.5 mg twice daily for 7—10 days and intramuscular (i.m.) CS every other day in accordance with the scheme: the first three injections at a dose of 1 ml (100 mg) on days 1, 3, and 5; if this was well tolerable, a dose of 2 ml (200 mg) from the 4th injection (on day 7). A control group (n=30) used meloxicam 7.5 mg twice daily for 7—10 days. Changes in the patients' status were evaluated at baseline and 10, 20, and 50 days after therapy. The authors used a numerical rating scale (NRS) to determine the intensity of pain (at rest, during walking, during palpation), as well as the Oswestry functional status scale (OFSS). Adverse events (AEs) were evaluated.

Results and discussion. In the study group, there was a decreased need for NSAIDs on day 7 of therapy, whereas in the control group, there were no dosage regimen changes through the treatment cycle. The intensity of pain syndrome according to the NRS decreased by 89.8% in the study group and by 68.3% in the control group; that according to OFSS reduced by 95.5% in the study group and by 86.6% in the control group (p<0.05). The use of i.m. CS injections in the combination therapy of LBP increases the efficiency of treatment, can reduce the dose of NSAIDs and improve the functional capabilities of the patients with pain syndrome. The safety of CS was confirmed by the absence of AEs throughout the follow-up period.

Conclusion. The investigation has demonstrated that the use of i.m. CS injections in the combination therapy of LBP can improve treatment outcomes.

About the Authors

O. A. Shavlovskaya
Research Department of Neurology, Biomedical Science and Technology Park I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Olga Aleksandovna Shavlovskaya.

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

I. D. Romanov
University Clinical Hospital Three, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation
11, Rossolimo St., Build. 1, Moscow 119021. 

Yu. S. Prokofyeva
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia; S.I. Spasokukotsky Moscow City Clinical Hospital, Moscow Healthcare Department
Russian Federation

20, Delegatskaya St., Build. 1, Moscow 127473; 21, Vuchetich St., Moscow 127206.


1. Unrelieved pain is a major global healthcare problem.

2. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Aug 22;386(9995): 743-800. doi: 10.1016/S0140-6736(15)60692-4. Epub 2015 Jun 7.

3. Urits I, Burshtein A, Sharma M, et al. Low back pain, a comprehensive review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep.2019 Mar 11;23(3):23. doi: 10.1007/s11916-019-0757-1.

4. Parfenov VA, Yakhno N.N., 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. (InRuss.). doi: 10.14412/2074-27112018-2-4-11

5. Parfenov VA, Yakhno NN, Davydov OS, et al. Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhi-atriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2S): 7-16. (In Russ.). doi: 10.14412/2074-2711-2019-2S-7-16

6. Zhivolupov SA, Litvinenko IV, Samartsev IN, et al. Drug therapy for chronic pain musculoskeletal pain syndromes: the concept of adjuvant analgesics and the prospect of its implementation. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(1):105-11. (In Russ.). doi: 10.14412/2074-2711-2020-1-105-111

7. Bjordal JM, Klovning A, Ljunggren AE, Slordal L. Short-term efficacy of pharma-cotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomized placebo-controlled trials. Eur J Pain. 2007 Feb; 11(2):125-38. doi: 10.1016/j.ejpain.2006.02.013. Epub 2006 May 8.

8. Alekseeva LI. Clinical guidelines update on the treatment of patients with osteoarthritis in 2019. Russkii meditsinskii zhurnal. 2019;(4):2-6. (In Russ.).

9. Geenen R, Overman CL, Christensen R, et al. EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018 Jun;77(6):797-807. doi: 10.1136/annrheumdis-2017-212662. Epub 2018 May 3.

10. Bruyere О, Cooper С, Pelletier JP, et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum.2014 Dec; 44(3):253-63. doi: 10.1016/j.semarthrit.2014.05.014. Epub 2014 May 14.

11. Martel-Pelletier J, Farran A, Montell E, et al. Discrepancies in composition and biological effects of different formulations of chondroitin sulfate. Molecules. 2015 Mar 6;20(3): 4277-89. doi: 10.3390/molecules20034277.

12. Chondroitin sulfate. Instructions for use of the drug.

13. Naumov AV, Tkacheva ON, Khovasova NO. Exacerbations of chronic back pain in comorbid patients: long-term therapy. Russkii meditsinskii zhurnal. 2018;2(5):35-42. (In Russ.).

14. Ignatova AV. Experience of using the drug Chondrogard as a part of medical-drug blockades in the treatment of facet syndrome and dysfunction of the sacroiliac joint in outpatient settings. Russkii meditsinskii zhurnal. 2013; 21(10):524-6. (In Russ.).

15. Lila AM, Gromova OA, Torshin IYu, et al. Molecular effects of chondroguard in osteoarthritis and herniated discs. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2017;9(3): 88-97. (In Russ.). doi: 10.14412/2074-27112017-3-88-97

16. Alekseeva LI, Sharapova EP, Kashevarova NG, et al. Comparative study of the efficacy and safety of Chondroguard® during its combined (intra-articular and intramuscular) and intramuscular injection in patients with knee osteoarthritis. Sovremennaya Revmatologiya= Modern Rheumatology Journal. 2018;12(2): 44-49. (In Russ.). doi: 10/14412/1996-70122018-2-44-49

17. Naumov AV, Sharov MN, Khovasova NO, Prokofieva YuS. Results of the intermittent regimen of initial pain therapy with chondroitin sulfate and glucosamine sulfate for patients with osteoarthritis, back pain and comorbidity. RMJ. 2018;26(4-2):47-54. (In Russ.).

18. Zolotovskaya IA, Davydkin IL. A antiresorptive-cytokine effects of chondroprotective therapyin patients with lower back pain. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2020; 120(4):65-71. (In Russ.)].

19. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology / Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-162. doi: 10.1002/acr.24131. Epub 2020 Jan 6.

20. Lila AM, Alekseeva LI, Taskina EA. Modern approaches to osteoarthritis therapy taking into account updated international guidelines. Russkii meditsinskii zhurnal. Meditsinskoe obozrenie.2019;3(11-2):48-52. (In Russ.).

21. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11): 1578-1589. doi: 10.1016/j.joca.2019.06.011.

22. Bruyere O, Honvo G, Veronese N, et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum.2019 Dec;49(3):337-350. doi: 10.1016/j.semarthrit.2019.04.008. Epub 2019 Apr 30.

23. Federal clinical guidelines for the diagnosis and treatment of osteoarthritis. All-Russian public organization «Association of rheumatologists of Russia». 2013.

24. Hochberg MC. Structure-modifying effects of chondroitin sulfate in knee osteoarthritis: an updated meta-analysis of randomized placebo-controlled trials of 2-year duration. Osteoarthritis Cartilage. 2010 Jun;18 Suppl 1: S28-31. doi: 10.1016/j.joca.2010.02.016. Epub 2010 Apr 27.

25. Lambert C, Mathy-Hartert M, Dubuc JE, et al. Characterization of synovial angiogenesis in osteoarthritis patients and its modulation by chondroitin sulfate. Arthritis Res Ther. 2012 Mar 12;14(2):R58. doi: 10.1186/ar3771.

26. Honvo G, Bruyere O, Geerinck A, et al. Efficacy of chondroitin sulfate in patients with knee osteoarthritis: a comprehensive meta-analy-sis exploring inconsistencies in randomized, placebo-controlled trials. Adv Ther. 2019 May;36(5):1085-1099. doi: 10.1007/s12325-019-00921-w. Epub 2019 Mar 16.

27. Identification number of the Protocol KI of the Ministry of health of the Russian Federation:KI/1216-1 «Double-blind placebo-controlled randomized study of the effectiveness and safety of the drug Chondrogard®, solution for intramuscular administration of 100 mg/ml (JSC «FarmFirma «Sotex», Russia) in patients with gonarthrosis».

For citation:

Shavlovskaya O.A., Romanov I.D., Prokofyeva Y.S. Experience with chondroitin sulfate in the combination therapy of lower back pain. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(3):75-81. (In Russ.)

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ISSN 2074-2711 (Print)
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