Problem of Pain in the Internist's Practice

Abstract

Introduction. Pain is an important problem in current medical practice and a fundamental issue of medical research. More than 75% of population suffers from chronic pain syndrome. One on seven patients who visit out-of-patient departments complains on painful feelings in joints or muscles. Moreover, in 30% of cases the symptoms of rheumatic diseases or the back pain syndrome are present that considerably impacts the quality of life. The aim of the study was to evaluate the effectiveness of the combined therapeutic strategy in the treatment of patients with osteoarthritis and comorbidities. The therapy included: glucosamine sulfatis in forms of solution for IV administration and powder for oral administration; patented form of undenaturated cartilaginous collagen (natural) type II (UC-ІІtm); non-steroidal anti-inflammatory drugs (meloxycam), angiotensin receptor type 2 blockers (valsartan), statins (rosuvastatin). Materials and methods. This prospective study was performed at the Department of Family Medicine and Therapy, Ukrainian Medical Stomatological Academy, and at Regional Rheumatology Centre of Poltava M. Sklifosovsliy Regional Clinical Hospital. 30 in- and out-patients aged 52-67 years having previously diagnosed primary gonarthrosis of X-ray stages ІІ–ІІІ by the Kellgren and Lawrence classification and any of the comorbid conditions (arterial hypertension, coronary arteries disease, chronic back pain syndrome, NSAIDS-induced gastropathy) were enrolled to the study, which lasted for 12 months. Results. Analyzing the effectiveness of the combined therapy for the patients with diagnosed osteoarthritis and concomitant conditions during the 12-month period of the study, we have found better results in the patients, who received chondroprotectors parenterally and orally. Significant clinical effect presumably caused by chondroprotectors in mixed forms among the patients with osteoarthritis and comorbid pathology was proved by the improvement in the following clinical parameters as the Leken index and WOMAC. In 6 months of the therapy, we achieved a significant decrease in the total functional Leken index (10.88 ± 2.07), p<0.0001 in the patients of the main group who received chondroprotectors in a mixed form compared to the control group (12.68 ± 2.08, p<0.0001). A significant decrease in the Leken index in the main group was also observed in 12 months since the theraoy started (p<0.0001), indicating the presence of long-term effects. We also observed the reducing in pain severity at rest and on movement, decline in the level of daily activities restrictions according to WOMAC questionnaire filled in 6 months since the therapy began. The findings supporting positive therapeutic effects fwere found in both groups, but in the main group they were more significant. The total WOMAC questionnaire score in 6 month treatment period was 676.08 ± 215.63 in the main group that was significantly lower compared to the control group (858.46 ± 167.64, p <0.0001). This clinical indicator was also significantly lower in the main group (564.82 ± 187.34) compared to the control group (797.12 ± 218.10, p <0.0001) in 12 month period.

Modern Chondroprotectors in the Therapy of Osteoarthritis

“…ОА належить до хвороб з дуже високим рівнем коморбідності, оскільки похилий вік -найбільш вагомий чинник серед усіх факторів ризику його розвитку. Причому встановлено, що у пацієнтів з ОА значно вищий ризик розвитку коморбідних станів, ніж у пацієнтів, які ним нестраждають [18,19]. Серед y найбільш часто діагностованих супутніх патологій при ОА є кардіота цереброваскулярна патологія (63%), цукровий діабет (34%), хронічне обструктивне захворювання легень (24%).…”

“…За даними літератури, у п'ятої частини хворих на ОА діагностується чотири і більше супутніх захворювання. У хворих на ОА важливим є врахування коморбідності з погляду ще й на загрозу кардіо-чи цереброваскулярних подій, а також загострень хвороб травного тракту [18,20,21]. Кожен п'ятий має серйозні, зокрема фатальні, серцево-судинні ускладнення [18,19,22,23,24].…”