The comprehensive pathogenetic approach used in analgesic therapy provides an effective and relatively safe relief of MSP in most patients with NBP and osteoarthritis.
BackgroundMusculoskeletal pain is the most common manifestation of osteoarthritis (OA) and non-specific back pain (BP). Treatment of pain includes medications with a different mechanism of action such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, muscle relaxants, antidepressants or local glucocorticoid (GC) injections. However, a uniform approach to sequential and complex therapy with these medications is not so far available.ObjectivesThe study aims at evaluating the efficacy of combined therapy of musculoskeletal pain in real clinical practice.MethodsIn the open-label study were included 3304 patients (54.3% women and 45.7% men with average age of 48.9±14.6 years) with acute/subacute pain due to OA or BP. The exclusion criteria were the presence of severe co-morbidities and BP in association with neurological disorders. Treatment was carried out in accordance with the following algorithm: for a moderate/severe pain (>4 scores according to an 11-point numeric rating scale, NRS) use of NSAID (aceclofenac), when NSAIDs are contraindicated – tramadol with/without paracetamol, in case of mild pain – topical NSAID with/without paracetamol, and muscle relaxants as indicated. Control of treatment efficacy was carried out on day 7 (a total of 4 visits). Change of therapy could be done at each visit and include switching to the other NSAID if the prescribed drug proved to be ineffective or intolerant, local glucocorticoid (GC) injection, addition of tramadol with/without paracetamol or administration of antidepressants or anticonvulsants. The results of treatment were assessed based on the dynamics of pain using NRS, a number of patients in whom pain was relieved completely and treatment satisfaction (a 0 to 5 rating scale where 0 is the absence of the effect or pain aggravation and 5 is an excellent effect).ResultsThe first prescribed medication in 97.5% of patients was oral NSAID (aceclofenac 200 mg per day) and in 67.6% of patients it was aceclofenac in combination with muscle relaxant. By visit 4, pain decreased from 6.9±1.5 to 2.2±1.3 points. Pain was completely relieved in 77.0% of patients. 227 patients (6.9%) dropped out of observation, and 16.1% of patients continued the use of analgesics after four weeks of treatment. The vast majority of patients (88.4%) evaluated treatment results as “good” or “excellent”. Switching to the other NSAID was required in 8.1% of patients, local injection of GC in 1.9%, administration of antidepressant or anticonvulsant in 1.5%, and hospitalization in 0.25% of patients. Adverse reactions (mostly dyspepsia) were noted in 2.2% of patients.ConclusionsThe use of treatment algorithm based on a complex pathogenetic approach ensures that patients receive an effective and relatively safe pain relief. Oral NSAIDs are the most expedient as first-line treatment in patients with moderate and severe musculoskeletal pain.Disclosure of InterestNone declared
BackgroundGastric or duodenal ulcers are one of the most common side effects of NSAIDs. These lesions are important as a cause of of life-threatening complications, such as GI-bleeding. Therefore, patients who had NSAIDs-induced ulcers in history require special control for the prophylaxis of GI-complications if they need to continue to use NSAIDs.ObjectivesTo compare the frequency of relapses of NSAIDs-induced ulcers in patients with rheumatic diseases who had long-term use of NSAIDs during the periods of 1996–2006 and 2011–2013.MethodsGroup 1 (1996–2006): 407 pts (85.3% females, 52.1±13.6 y.o.), with gastric or duodenal ulcers, which developed during NSAIDs treatment; and 1640 pts (83.1% females, aged 50.1±14.6 y.o.), who didn't develop ulcer during NSAIDs intake. Group 2 (2011–2013): 82 pts (80.6% females, 58.3±12.7) with NSAIDs-induced gastric or duodenal ulcers, and 206 pts (85.1% females, 51.7±15.2 y.o.), without GI lesions during NSAIDs therapy. Patients from Group 1 used selective COX-2 inhibitors (coxibs) less in comparison to pts from Group – 4.9% vs 15.7%, as well as proton pump inhibitors (PPIs) – 14.6% vs 47.6% (p=0.000). All pts continued to use NSAIDs at least for one year after the first upper gastrointestinal endoscopy (UGE). All patients underwent repeated UGE after 12 months.ResultsRelapse of NSAID-induced ulcers were documented in 40.7% pts from Group 1, and in 28.0% pts from Group 2. Another situation was observed in patients of group 1 and 2 who did not have NSAID-induced GI lesions according data of first UGE. All of them continued to use NSAIDs ≥12 month and only 6.5% and 2.4% had developed ulcers according data of second UGE, respectively. PPI use significantly reduced the risk of relapsing NSAIDs-induced ulcers in Group 1 and 2: odds ratio (OR) 0.51 (95% CI 0.28–0.67) and OR 0.47 (95% CI 0.11–0.74).ConclusionsRelapses of NSAID-induced ulcers still remain a serious problem. Pts with NSAID-induced ulcers in history should be protected with PPIs if they require continuation of using NSAIDs. Patients, who have not observed the development of NSAID-gastropathy with short-term NSAID therapy, have a lower risk of developing these lesions by continuing to use them for a long time.Disclosure of InterestNone declared
Цель обзора. Представить данные о целесообразности проведения эрадикации Helicobacter pylori (H. pylori) у больных с эрозиями и язвами, возникшими на фоне терапии нестероидными противовоспалительными препаратами (НПВП). Основные положения. Согласно положениям Маастрихтского консенсуса 2012 г., инфекция H. pylori и прием НПВП -основные и независимые этиологические факторы пептической язвы и кровотечения из верхних отделов желудочно-кишечного тракта (ЖКТ). Однако точных данных о взаимном влиянии H. pylori и НПВП на развитие патологии ЖКТ нет. Этот вопрос имеет принципиальное значение, поскольку большая часть больных (в России -более 50%), нуждающихся в приеме
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.