Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Pain reliever combinations in treatment of patients with acute musculoskeletal back pain

Full Text:


Objective: to compare the clinical efficacy of complex therapy, including a combination of a nonsteroidal anti-inflammatory drug (NSAID) with a muscle relaxant and B vitamins in acute musculoskeletal back pain (MSBP).

Patients and methods. We enrolled 66 patients with acute MSBP, 27 men and 39 women, mean age – 52.8 [29.4; 68.8] years. All patients had different pain localization: 36 (54.5%) – lumbodynia, 22 (33.3%) – cervicodynia, 8 (12.2%) –  thoracodynia. Visual analog scale (VAS) was used to assess pain intensity. Patients in the 1st group (n=32) were prescribed with complex therapy, including Russian drugs meloxicam (Amelotex 15 mg per day), tolperison (Kalmirex), and a neurotropic  multivitamin supplement Compligam B. Patients in the 2nd  group (n=34) received a combination of only two of the three drugs. We assessed pain intensity with VAS, disability duration, and treatment effectiveness from the doctor's and patient's perspectives. 

Results and discussion. After 5 days of treatment, pain regression was noted in both groups; pain reduction by 50% or more from the initial level prevailed in 1st group (p=0.03). A rapid NSAID dose decrease prevailed in the 1st group; from the 5th to the 10th day, all patients switched to the 7.5 mg meloxicam dose. The duration of temporary disability in the 1st group was less than 7 days, in the 2nd group – 9 days (p<0.05). Complex therapy in group 1 was more effective than therapy in group 2, according to doctors and patients (p<0.05). 

Conclusion. The combination of NSAID with a muscle relaxant and B vitamins can reduce the duration and the incidence of  adverse drug reactions of NSAID therapy, and reduce the  duration of temporary disability. 

About the Authors

R. V. Gorenkov
N.A. Semashko National Research Institute of Public Health; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

12, Vorontsovo Pole St., Build. 1, Moscow 105064, Russia;

8, Trubetskaya, Build. 2, Moscow 119991, Russia 

M. N. Dadasheva
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

 61/2, Shchepkin St., Build. 1, Moscow 129110, Russia 

D. I. Lebedeva
Tyumen State Medical University, Ministry of Health of Russia
Russian Federation

 54, Odesskaya St., Tyumen 625048, Russia 

I. V. Choi
Central Clinical Hospital of the Russian Academy of Sciences
Russian Federation

 1A, Litovskiy Blvd., Moscow 117593, Russia 


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

2. Barbero M, Schneebeli A, Koetsier E, Maino P. Myofascial pain syndrome and trigger points: evaluation and treatment in patients with musculoskeletal pain. Curr Opin Support Palliat Care. 2019 Sep;13(3):270-6. doi: 10.1097/SPC.0000000000000445

3. Austine J, Nair S, Mirza K. Perspective of orthopedists on pain management in osteoarthritis: a qualitative study. Indian J Palliat Care. Oct-Dec 2016;22(4):410-5. doi: 10.4103/0973-1075.191764

4. Castellsague J, Riera-Guardia N, Calingaert B, et al. Individual NSAIDs and upper gastrointestinal complications: a systematic review and meta-analysis of observational studies (the SOS project). Drug Saf. 2012 Dec 1;35(12):1127-46. doi: 10.2165/11633470-000000000-00000

5. Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014 May;25(2):357-74. doi: 10.1016/j.pmr.2014.01.012. Epub 2014 Mar 17.

6. Podchufarova EV, Yakhno NN. Bol' v spine [Pain in the back]. Moscow: GEOTAR-Media; 2013. 368 p. (In Russ.).

7. McCann DJ, Petry NM, Bresell A, et al. Medication nonadherence, «professional subjects», and apparent placebo responders: overlapping challenges for medications development. J Clin Psychopharmacol. 2015 Oct;35(5):566-73. doi: 10.1097/JCP.0000000000000372

8. Kim HK, Park JH, Park JH, Kim JH. Differences in adherence to antihypertensive medication regimens according to psychiatric diagnosis: results of a Korean population-based study. Psychosom Med. 2010 Jan;72(1):80-7. doi: 10.1097/PSY.0b013e3181c4e3e9. Epub 2009 Nov 20.

9. Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med. 2005 May 3;142(9):776-85. doi: 10.7326/0003-4819-142-9-200505030-00014

10. Jordan JL, Holden MA, Mason EE, et al. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2010 Jan 20;2010(1):CD005956. doi: 10.1002/14651858.CD005956.pub2

11. 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.).

12. Rivers WE, Garrigues D, Graciosa J, et al. Signs and symptoms of myofascial pain: An international survey of pain management providers and proposed preliminary set of diagnostic criteria. Pain Med. 2015 Sep;16(9):1794-805. doi: 10.1111/pme.12780. Epub 2015 Jun 5.

13. Van Tulder MW, Touray T, Furlan AD, et al; Cochrane Back Review Group (2003). Muscle relaxants for nonspecific low back pain: A systematic review within the framework of the cochrane collaboration. Spine (Phila Pa 1976). 2003 Sep 1;28(17):1978-92. doi: 10.1097/01.BRS.0000090503.38830.AD

14. Gazoni FM, Malezan WR, Santos FC. B complex vitamins for analgesic therapy. Rev Dor Sao Paulo. 2016;17(1):52-6.

15. Bollen JC, Dean SG, Siegert RJ, et al. A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties. BMJ Open. 2014 Jun 27;4(6):e005044. doi: 10.1136/bmjopen-2014-005044

16. McLean S, Holden MA, Potia T, et al. Quality and acceptability of measures of exercise adherence in musculoskeletal settings: a systematic review. Rheumatology (Oxford). 2017 Mar 1;56(3):426-38. doi: 10.1093/rheumatology/kew422

17. Hall AM, Kamper SJ, Hernon M, et al. Measurement tools for adherence to nonpharmacologic self-management treatment for chronic musculoskeletal conditions: a systematic review. Arch Phys Med Rehabil. 2015 Mar;96(3):552-62. doi: 10.1016/j.apmr.2014.07.405. Epub 2014 Aug 6.


For citations:

Gorenkov R.V., Dadasheva M.N., Lebedeva D.I., Choi I.V. Pain reliever combinations in treatment of patients with acute musculoskeletal back pain. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(2):73-78. (In Russ.)

Views: 234

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

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