Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Nonsteroidal anti-inflammatory drugs, muscle relaxants, and B-group vitamins in the treatment of lumbar ischialgia

https://doi.org/10.14412/2074-2711-2020-6-71-76

Full Text:

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are used orally or intramuscularly (IM) to treat lumbar ischialgia caused by musculoskeletal disorders or radiculopathy. A comparative study has been conducted to investigate the efficacy and safety of the NSAID meloxicam (Amelotex®) injected intramuscularly and into the trigger points in combination with tolperisone and B-group vitamins for lumbar ischialgia.

Patients and methods. The investigation enrolled 62 patients aged 30–60 years with lumbar ischialgia, who were randomized into three equal groups. Group 1 patients were injected with meloxicam 1.5 ml (15 mg of its active ingredient) into the trigger points daily for 3 days, followed by one 15-mg tablet daily for 14 days; Group 2 received IM meloxicam 15 mg daily for 3 days, followed by one 15-mg tablet daily for 14 days; Group 3 had IM meloxicam 15 mg daily for 3 days, followed by one 15-mg tablet daily for 14 days in combination with tolperisone (Calmirex®) as tablets: 150 mg (Day 1 of therapy), 300 mg (Day 2), and 450 mg daily (Day 3 until the end of therapy). All the patients received IM Vitamin B complex (Compligam B®) 2 ml for 5 days. The treatment efficiency was evaluated using the pain visual analogue scale (VAS), the Oswestry disability questionnaire, and the McGill pain questionnaire, the range of motion, and the severity of neurodystrophic syndrome.

Results and discussion. All the patient groups showed a rapid and substantial pain reduction on the VAS and a functional activity improvement according to the Oswestry scale, which made it possible to complete the treatment within an average of 9.6 days. Groups 3 and 1 exhibited a faster improvement and, as a result, a shorter therapy duration on 8.6±1.2 and 9.2±0.9 days than did Group 2 (8.6±1.2 days). On day 2 of treatment, there was a more considerable pain reduction on the VAS in Group 1 that received meloxicam injections into the trigger zones. The administration of meloxicam intramuscularly and into the trigger zones in combination with tolperisone and vitamin B complex was noted to be safe and well tolerated.

Conclusion. The injection of Amelotex into the trigger zones is highly effective and safe in treating lumbar ischialgia. An NSAID (meloxicam) in combination with a muscle relaxant (tolperisone) speeds up recovery and shortens the duration of NSAID intake.

About the Authors

V. A. Shirokov
Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being
Russian Federation

Vasily Afonasyevich Shirokov

30, Popov St., Yekaterinburg 620014



A. V. Potaturko
Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being
Russian Federation

30, Popov St., Yekaterinburg 620014



N. L. Terekhov
Yekaterinburg Medical Research Center for Prophylaxis and Health Protection in Industrial Workers, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being
Russian Federation

30, Popov St., Yekaterinburg 620014



References

1. Shamburov DA. Ishias [Sciatica]. Moscow: Medgiz; 1950. 188 p. (In Russ.).

2. Popelyanskiy YaYu. Bolezni perifericheskoy nervnoy sistemy: Rukovodstvo dlya vrachey [Diseases of the Peripheral Nervous System: A Guide for Physicians.]. Moscow: MEDpressinform; 2005. 368 p. (In Russ.).

3. Altunbaev RA, Sibgatullin MM, Sabirova MZ, et al. Lumboischialgia variants: vertebrogenic and non-vertebral mechanisms. Rossiyskiy zhurnal boli. 2012;(1):47 (In Russ.).

4. Churyukanov MV, Shevtsova GE, Zagorulko OI. A neuropathic component of lumboischialgia: mechanisms of development and treatment approaches. Zhurnal nevrologii i psikhiatrii. 2017;(1):90-6. doi: 10.17116/jnevro20171171190-96 In Russ.).

5. Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain. 2009 Dec 15;147(1-3):17-9. doi: 10.1016/j.pain.2009.08.020. Epub 2009 Sep 16.

6. Defrin R, Brill S, Goor-Arieh I. «Shooting pain» in lumbar radiculopathy and trigeminal neuralgia, and ideas concerning its neural substrates. Pain. 2020 Feb;161(2):308-18. doi: 10.1097/j.pain.0000000000001729

7. Kremer U. Zabolevaniya mezhpozvonkovykh diskov [Diseases of the intervertebral discs]. Ed. Shirokov VA. Moscow: MEDpress-inform; 2015. 472 p. (In Russ.).

8. McKenzie RA. The lumbar spine: Mechanical diagnosis and therapy. Waikanae, New Zealand: Spinal Publications; 1981.

9. Mumentaler M, Shter M, Müller-Fall G. Porazheniye perifericheskikh nervov i koreshkovyye sindromy [Lesion of peripheral nerves and radicular syndromes]. Moscow: MEDpress-inform; 2013 (In Russ.).

10. Simons DG, Trevell DG, Simons LS. Trevell i Simons. Miofastsial'nyye boli i disfunktsii: Rukovodstvo po triggernym tochkam [Myofascial Pain and Dysfunction: A Guide to Trigger Points]. In 2 vol. 2nd ed. Moscow: Meditsina; 2005. 1192 p. (In Russ.).

11. Baron R, Binder A, Attal N, et al. Neuropathic low back pain in clinical practice. Eur J Pain. 2016 Jul;20(6):861-73. doi: 10.1002/ejp.838. Epub 2016 Mar 2.

12. Badokin VV. Tolerability and safety of meloxicam.. Russkiy meditsinskiy zhurnal. 2007;15(26):2037-41 (In Russ.).

13. Bosch H, Sigmund R, Hettich M. Efficacy and tolerability of intramuscular and oral meloxicam in patients with acute lumbago: comparison with intramuscular and oral piroxicam. Curr Med Res Opinion. 1997;14(1):29-38. doi: 10.1185/03007999709113340

14. Colberg K, Netting M, Sigmund R, et al. The efficacy and tolerability of an 8-day administration of intravenous and oral meloxicam: a comparison with intramuscular and oral diclofenac in patients with acute lumbago. Curr Med Res Opinion. 1996;13(7):363-77. doi: 10.1185/03007999609111556

15. Parfenov VA, Isaikin AI, Kuzminova TI, et al. Treatment of patients with acute and subacute lumbodynia and lumbar ischialgia. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3):57- 62. doi: 10.14412/2074-2711-2019-3-57-62 (In Russ.).

16. Gerasimova ON, Parfenov VA. Clinical experience with meloxicam (Movalis®) in nonspecific back pain and radiculopathy. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;4(2):68- 73. doi: 10.14412/2074-2711-2012-387 (In Russ.).

17. 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. doi: 10.14412/2074-2711-2018-2-4-11 (In Russ.).

18. Kukushkin ML, Brylev LV, Laskov VB, et al. Results of a randomized double blind parallel study on the efficacy and safety of tolpersione in patients with acute nonspecific low back pain. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017;117(11):69-78 (In Russ.).

19. Skorobogatykh KV, Azimova YuE. Efficacy of tolperisone versus meloxicam in the treatment of nonspecific acute neck pain. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(2):37-41. doi: 10.14412/2074-2711-2020-2-37-41 (In Russ.).

20. Parfenov VA, Yakhno NN, Davydov OS, et al. Discogenic lumbosacral radiculopathy. Recommendations of the Russian Association for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):15- 24. doi: 10.14412/2074-2711-2020-4-15-24 (In Russ.).


For citation:


Shirokov V.A., Potaturko A.V., Terekhov N.L. Nonsteroidal anti-inflammatory drugs, muscle relaxants, and B-group vitamins in the treatment of lumbar ischialgia. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(6):71-76. (In Russ.) https://doi.org/10.14412/2074-2711-2020-6-71-76

Views: 889


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)