Combination therapy for pain in musculoskeletal diseases
https://doi.org/10.14412/2074-2711-2012-427
Abstract
When managing patients with locomotor pathology, serious attention is paid to symptomatic therapy aimed at eliminating the unpleasant manifestations of the disease. At the same time, rational analgesia is of the greatest importance. If acute pain should be arrested, parenteral or tableted formulations of fast-acting analgesics are used for days. Longer analgesic therapy especially for clinically relevant inflammation is based on the use of nonsteroidal anti-inflammatory drugs (NSAID) having analgesic and anti-inflammatory effectiveness and good tolerance. The level of analgesia may be increased, by combining NSAID with tramadol and paracetamol. When clinical muscular spasm is implicated in the pathogenesis of chronic pain, it is expedient to prescribe myorelaxants that have an analgesic potential and are able to potentiate the analgesic effect of NSAID.
References
1. <div><p>Ревматология. Клинические рекомендации. Под ред. акад. Е.Л. Насонова. М.: ГЭОТАР-Медиа, 2010;752 с.</p><p>Насонов Е.Л., Насонова В.А. Фармакотерапия боли: взгляд ревматолога. Cons med 2000;2(12):7-14.</p><p>Боль (практическое руководство для врачей). Под ред. Н.Н. Яхно, М.Л. Кукушкина. М.: Изд-во РАМН, 2012;512 c.</p><p>Nüesch E., Dieppe P., Reichenbach S. et al. All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study. BMJ 2011;342:d1165. doi: 10.1136/bmj.d1165.</p><p>Tsuboi M., Hasegawa Y., Matsuyama Y. et al. Do musculoskeletal degenerative diseases affect mortality and cause of death after 10 years in Japan? J Bone Miner Metab 2011;29(2):217-23.</p><p>Zhu K., Devine A., Dick I. et al. Association of back pain frequency with mortality, coronary heart events, mobility, and quality of life in elderly women. Spine 2007;32(18):2012—8.</p><p>Arboleya L., de la Figuera E., Soledad Garcia M. et al. Management pattern for patients with osteoarthritis treated with traditional non steroidal anti-inflammatory drugs in Spain prior to introduction of Coxibs. Curr Med Res Opin 2003;19(4):278-87.</p><p>Gore M., Sadosky A., Leslie D. et al. Therapy Switching, Augmentation, and Discontinuation in Patients with Osteoarthritis and Chronic Low Back Pain. Pain Pract 2012;12(6):457-68.</p><p>Чичасова Н.В. Проблема боли при остеоартрозе. Леч врач 2007;2:18-25</p><p>Bianchi M., Martucci C., Ferrario P. et al. Increased Tumor Necrosis Factor- and Prostaglandin E2 Concentrations in the Cerebrospinal Fluid of Rats with Inflammatory Hyperalgesia: The Effects of Analgesic Drugs. Anest Analg 2007;104:949-54.</p><p>McCrory C., Fitzgerald D. Spinal prostaglandin formation and pain perception following thoracotomy: a role for cyclooxyge-nase-2. Chest 2004;125(4):1321-7.</p><p>Tassorelli C., Greco R., Sandrini G. et al. Central components of the analgesic/antihyperalgesic effect of nimesulide: studies in animal models of pain and hyperalgesia. Drugs 2003;63(Suppl 1):9—22.</p><p>Dembo G., Park S., Kharasch E. Central nervous system concentrations of cyclooxygenase-2 inhibitors in humans. Anesthesiology 2005;102(2):409-15.</p><p>Каратеев А.Е., Яхно Н.Н., Лазебник Л.Б. и др. Применение нестероидных противовоспалительных препаратов. Клинические рекомендации. М.: ИМА-ПРЕСС, 2009;167 с.</p><p>De Oliveira G., Agarwal D., Benzon H. Perioperative Single Dose Ketorolac to Prevent Post-operative Pain: A Meta-Analysis of Randomized Trials. Anesth Analg 2012;114(2):424—33.</p><p>Gillis J., Brogden R. Ketorolac. A reappraisal of its pharmacodynamic and pharmacokinetics and therapeutics use in pain management. Drug 1997;53:139-88</p><p>Martin Carrasco C., Rodriquez Vasquez M., Palacios Garsia R. A double-blind study of analgesic efficacy in kidney colic of the combination of dipyrone and spasmolytic with ketorolac trometamol. Arch Esp Urol 1993;46:763-8.</p><p>Marin-Bertolin S., de Andres J., Gonzalez-Martinez R. et al. A controlled, randomized, double-blind study of ketorolac for postoperative analgesia after plastic surgery. Ann Plast Surg 1997;38:478-84.</p><p>Gonzalez-Garcia C.A., Ibarra-Ibarra L.G., Barbosa-Vivanco S. Comparative study of ketoralac and dipyrone administered orally in the treatment of postoperative pain. Proc West Pharacol Soc 1994;37:121-2 (abstr).</p><p>Меладзе З.А., Гунько В.И., Бутров А.В. Применение НПВП в амбулаторной хирургической стоматологии. Тезисы конференции «Клинические и теоретические аспекты боли», М., 2001.</p><p>Верткин А.А., Вовк Е.И., Наумов А.В. и др. Некоторые вопросы дифференциального назначения лекарственных препаратов для терапии острой боли. www.intensive.ru</p><p>Галушко Е.А., Зоткин Е.Г., Салихов И.Г. и др. Клиническая эффективность и пере носимость НПВП при остеоартрозе с выраженным болевым синдромом. Леч врач 2008;4:32-8.</p><p>Forrest J., Camu F., Greer I.A. Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery. British J Anaesth 2002;88:227-33.</p><p>В.Г. Барскова. Письмо редактора. Совр ревматол 2011;2:82-3.</p><p>Mattia C., Ciarcia S., Muhindo A. et al. Nimesulide: 25 years later. Minerva Med 2010;101(4):285-93.</p><p>Насонов Е.Л. Эффективность и переносимость нестероидного противовоспалительного препарата. Нимесулид: новые данные. РМЖ 2001;15:6-8.</p><p>Rainsford K. Current status of the therapeutic uses and actions of the preferential cyclo-oxygenase-2 NSAID, nimesulide. Inflammopharmacology 2006;14(3—4):120—37.</p><p>Bennett A. Nimesulide a well established cyclooxygenase-2 inhibitor with many other pharmacological properties relevant to inflammatory diseases. In: Therapeutic Roles of Selective COX-2 Inhibitors. J.R. Vein, R.M. Botting (eds). London: William Harvey Press, 2001;524-40.</p><p>Bradbury F. How important is the role of the physician in the correct use of a drug? An observational cohort study in general practice. Int J Clin Pract (Suppl) 2004;144:27-32.</p><p>Conforti A., Leone R., Moretti U. et al. Adverse drug reactions related to the use of NSAIDs with a focus on nimesulide: results of spontaneous reporting from a Northern Italian area. Drug Saf 2001;24:1081-90.</p><p>Laporte J., Ibanez L., Vidal X. et al. Upper gastrointestinal bleeding associated with the use of NSAIDs: newer versus older agents. Drug Saf 2004;27:411-20.</p><p>Helin-Salmivaara A., Virtanen A., Veslainen R. et al. NSAID use and the risk of hospitalisation for first myocardial infarction in the general population: a national case-control study from Finland. Eur Heart 2006;27:1657-63.</p><p>Каратеев А.Е. Российский опыт применения нимесулида: обзор клинических испытаний. Cons med 2011;13(9):89-95.</p><p>Каратеев А.Е., Алексеева Л.И., Братыгина Е.А. и др. Оценка частоты развития побочных эффектов при длительном применении нимесулида в реальной клинической практике. РМЖ 2009;17(21):1466-72.</p><p>Каратеев А.Е., Насонова В.А. Развитие и рецидивирование язв желудка и двенадцатиперстной кишки у больных, принимающих нестероидные противовоспалительные препараты: влияние стандартных факторов риска. Тер арх 2008;5:62-6.</p><p>Fitzcharles M., Lussier D., Shir Y. Management of chronic arthritis pain in the elderly. Drugs Aging 2010;27(6):471—90.</p><p>Ong C., Seymour R., Lirk P. et al. Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg 2010;110(4): 1170-9.</p><p>Pavelka K., Peliskova Z., Stehlikova H. et al. Intraindividual differences in pain relief and functional improvement in osteoarthritis with diclofenac or tramadol. Clin Drug Investig 1998;16(6):421-9.</p><p>O’Donnell J., Ekman E., Spalding W. et al. The effectiveness of a weak opioid medication versus a cyclo-oxygenase-2 (COX-2) selective non-steroidal anti-inflammatory drug in treating flare-up of chronic low-back pain: results from two randomized, double-blind, 6-week studies. J Int Med Res 2009;37(6):1789-802.</p><p>Cepeda M., Camargo F., Zea C. et al. Tramadol for osteoarthritis: a systematic review and metaanalysis. J Rheum 2007;34(3):543-55.</p><p>Emkey R., Rosenthal N., Wu S. et al. Efficacy and safety of tramadol/acetaminophen tablets (Ultracet) as add-on therapy for osteoarthritis pain in subjects receiving a COX-2 nonsteroidal antiinflammatory drug: a multicenter, randomized, double-blind, placebo-controlled trial. J Rheum 2004;31(1):150-6.</p><p>Beebe F., Barkin R., Barkin S. A clinical and pharmacologic review of skeletal muscle relaxants for musculoskeletal conditions. Am J Ther 2005;12(2):151-71.</p><p>Richards B., Whittle S., van der Heijde D. et al. The Efficacy and Safety of Muscle Relaxants in Inflammatory Arthritis: A Cochrane Systematic Review. J Rheum Suppl 2012;90:34-9.</p><p>Richards B., Whittle S., van der Heijde D. et al. Efficacy and Safety of Neuromodulators in Inflammatory Arthritis: A Cochrane Systematic Review. J Rheum Suppl 2012;90:28-33.</p><p>Richards B., Whittle S., van der Heijde D. et al. Efficacy and Safety of Antidepressants in Inflammatory Arthritis: A Cochrane Systematic Review. J Rheum Suppl 2012;90:21-7.</p><p>Van Tulder M., Touray T., Furlan A. et al. Muscle relax ants for non-specific low back pain. Cochrane Database Syst Rev 2003;(2):CD004252.</p><p>Berry H., Hutchinson D. A multicentre placebo-controlled study in general practice to evaluate the efficacy and safety of tizanidine in acute low-back pain. J Int Med Res 1988;16(2):75-82.</p><p>Berry H., Hutchinson D. Tizanidine and ibuprofen in acute low-back pain: results of a double-blind multicentre study in general practice. J Int Med Res 1988;16(2):83—91.</p><p>Sirdalud Ternilin Asia-Pacific Study group. Efficacy and gastroprotective effects of tizanidine plus diclofenac versus placebo plus diclofenac in patients with painful muscle spasm. Curr Ther Res 1998;59:13-22.</p><p>Pareek A., Chandurkar N., Chandanwale A. 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;18(12):1836-42.</p><p>Данилов А.Б. Возможности применения тизанидина (Сирдалуда) в клинической практике. РМЖ 2009;17(19):1-7.</p></div><br />
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For citations:
Karateev AE. Combination therapy for pain in musculoskeletal diseases. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;4(4):76-83. (In Russ.) https://doi.org/10.14412/2074-2711-2012-427
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