Oral treatment with ALA for 5 weeks improved neuropathic symptoms and deficits in patients with DSP. An oral dose of 600 mg once daily appears to provide the optimum risk-to-benefit ratio.

Alcoholic myopathy is characterized by the reduction in cross-sectional area (CSA) of muscle fibers and impaired anabolic signaling. The goal of the current study was to investigate the causes and compare the changes in CSA and fiber type composition with the modifications of anabolic and catabolic signaling pathways at the early stages of chronic alcohol consumption in women. Skeletal muscle samples from 5 female patients with alcohol abuse (AL; 43 ± 5 yr old; alcohol abuse duration 5,6 ± 0,6 yr) were compared with the muscle from the control group of 8 healthy women (C; 35 ± 4 yr old). The average daily dose of alcohol consumption was 110 ± 10 ml of pure ethanol. In women patients, a significant decrease in CSA of type I and II muscle fibers, titin and nebulin content, plasma IGF-1 level and total IRS-1, p-Akt and p-4E-BP1 in vastus lateralis was found in comparison with the control group. The p-AMPK level was found to be increased versus the control group. In women patients with chronic alcoholic myopathy 1) both fast and slow muscle fibers are subjected to atrophy; 2) impairments in IGF-I-dependent signaling and pathways controlling translation initiation (AMPK/mTOR/4E-BP1), but not translation elongation, are observed; 3) the level of calpain-1 and ubiquitinated proteins increases, unlike E3 ligases content.

Background Low back pain (LBP) is second only to common cold as the most frequent reason for seeking medical care and is the leading cause of Years Lived with Disability (YLD) worldwide (1). LBP often creates a therapeutic challenge due to its unclear etiology and multiple interventions of uncertain efficacy. Significant proportion of LBP may be attributed to osteoarthritis (OA) and degenerative changes in the spine. Glucosamine-chondroitin sulfate (GCS) combination is widely used in the treatment of OA, despite conflicting evidence of its efficacy; however there are few prospective scientific investigations of its therapeutic merits in the management of LBP. Objectives To study the efficacy and safety of GCS in the community management of LBP in a large-scale open pilot prospective interventional study. Methods We enrolled patients between 40 and 65 years of age who had LBP for at least 12 weeks with a pain intensity >3 on a 0-10 point visual analogue scale (VAS). Major exclusion criteria were the presence of fibromyalgia, degenerative spondylolisthesis, and alcohol and/or drug abuse. All patients were treated with ARTRA (combination of glucosamine hydrochloride 500 mg and chondroitin sulfate 500 mg in tablet form; Unipharm Inc.) at a dose of 1 tab bid for the first month and then 1 tab daily for the next two months. The primary endpoint was pain intensity (at rest and movement) as measured on a 0-10 point VAS. Secondary endpoints included the Oswestry Disability Index, patient global assessment of efficacy (0-5 scale) and NSAID consumption. Results A total of 8,598 subjects (mean age 52.1 years, 67.3% women, mean BMI 27.4) were enrolled in the study, and formed the intent-to-treat (ITT) population. All but 95 subjects (1.1%) completed the study. ITT analysis with worst observation carried forward (WOCF) showed an improvement in pain at rest from mean (± SD) of 5.2 ± 1.9 at study entry to 1.4±1.6 at 3 months (p<0.0001). Pain at movement decreased from 6.8±1.6 to 2.2 ±1.8 (p<0.0001). The Oswestry disability index improved by almost 75%, from 21.1±9.7 to 5.3±6.0 (p<0.0001) at 3 months. NSAIDs were used by 63.4% of patients at study entry; at 3 months of treatment, only 7.4% of patients required NSAIDs for pain control (p<0.0001). An adverse event (AE) was reported by 604 (7.0%) patients (mostly gastrointestinal in origin, such as nausea, abdominal pain and dry mouth) but only 85 (1.0%) patients deemed it severe enough to discontinue therapy. Conclusions Although open and uncontrolled, this large community-based study shows dramatic reductions in pain and disability, and in particular, a 88% reduction in NSAID consumption in patients with LBP treated with GCS. With its benign safety profile, GCS therapy deserves serious evaluation in the management of LBP in a prospective randomized double-blinded clinical trial. References Vos T, Flaxman A, Naghavi M et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Diseas...

Хроническая неспецифическая боль в нижней части (БНЧС)-самая частая причина нарушения трудоспособности и снижения качества жизни в современном обществе. Цель исследования-обсуждение целесообразности выявления причин хронической неспецифической БНЧС и в случае обнаружения поражения фасеточного сустава (ФС) или крестцово-подвздошного сочленения (КПС) применения нестероидных противовоспалительных препаратов (НПВП) и введения анестетиков и глюкокортикоидов в область ФС или КПС. Пациенты и методы. Под наблюдением находилась 121 пациентка с хронической неспецифической БНЧС в возрасте от 22 до 59 лет. Поражение ФС выявлено у 53 (43,8%) больных. Пациентки были информированы о благоприятном прогнозе заболевания, получили рекомендации по двигательной активности, им также были назначены НПВП и миорелаксанты. У 28 (23%) пациенток клинически значимый обезболивающий эффект был достигнут в течение 2 нед; у остальных 93 (77%) проведена комплексная терапия с введением анестетиков в область ФС и КПС. Результаты и обсуждение. Показано, что основой успешной персонифицированной терапии у таких больных является адекватная диагностика с выявлением преобладающих источников болевой импульсации (триггеров), в том числе с использованием малоинвазивных методов диагностики-локального введения раствора местного анестетика в предполагаемый триггер боли. Высокая эффективность включения в комплексную терапию хронической неспецифической БНЧС введения анестетиков в область ФС и КПС во многом связана с быстрым устранением боли, что имеет большое психологическое значение. Обсуждаются центральные механизмы действия НПВП, в частности эторикоксиба. Заключение. Таким образом, выяснение причин хронической неспецифической БНЧС у пациента позволяет рекомендовать персонифицированную терапию, направленную на устранение не только симптомов, но и первопричины заболевания. Применение при поражении ФС эторикоксиба, отличающегося максимальной анальгетической эффективностью у больных остеоартритом, патогенетически оправдано и должно сочетаться с нелекарственными методами лечения.

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