Боль в спине: подбор терапии с точки зрения безопасности и эффективности
Боль в спине: подбор терапии с точки зрения безопасности и эффективности
Пилипович А.А. Боль в спине: подбор терапии с
точки зрения безопасности и эффективности. Consilium Medicum. 2017; 19 (2.3.
Неврология и Ревматология): 56–62. DOI: 10.26442/2075-1753_19.2.3.56-62
________________________________________________
Pilipovich A.A. Back pain: selection of therapy in terms of safety and efficacy. Consilium Medicum. 2017; 19 (2.3. Neurology and Rheumatology): 56–62. DOI: 10.26442/2075-1753_19.2.3.56-62
Боль в спине: подбор терапии с точки зрения безопасности и эффективности
Пилипович А.А. Боль в спине: подбор терапии с
точки зрения безопасности и эффективности. Consilium Medicum. 2017; 19 (2.3.
Неврология и Ревматология): 56–62. DOI: 10.26442/2075-1753_19.2.3.56-62
________________________________________________
Pilipovich A.A. Back pain: selection of therapy in terms of safety and efficacy. Consilium Medicum. 2017; 19 (2.3. Neurology and Rheumatology): 56–62. DOI: 10.26442/2075-1753_19.2.3.56-62
Боль в спине (дорсалгия) – одна из самых частых патологий. Распространенность болей в нижней части спины достигает 40–80%. Боли в спине могут наблюдаться в клинической картине как неврологических, так и соматических заболеваний. Наиболее часто встречаются боли в спине невисцеральной природы. Они характерны для заболеваний костно-мышечной системы и соединительной ткани области позвоночного столба (дорсопатий). Лечение дорсалгии включает борьбу с острыми приступами болей и поддерживающее, профилактическое лечение в межприступный период. Чем раньше начато лечение и быстрее достигнут адекватный анальгетический эффект, тем меньше вероятность хронизации боли и лучше общий прогноз. Перспективным в плане терапии болевого синдрома является препарат группы селективных активаторов нейрональных калиевых каналов – флупиртин. За счет уникального механизма действия флупиртин открывает ряд дополнительных терапевтических возможностей и преимуществ: влияние на центральные механизмы боли и возможность предотвращения хронизации, миорелаксирующее действие в области боли, возможность нейропротекторного действия, отсутствие ряда характерных для опиоидов и нестероидных противовоспалительных препаратов побочных эффектов.
Back pain (dorsalgia) is one of the most common pathologies. The prevalence of pain in the lower back reaches 40–80%. Back pain can be observed in the clinical picture of both neurological and somatic diseases, and the pains of non-vascular nature are most commonly observed, being characteristic for diseases of the musculoskeletal system and connective tissue of the region of the spine (dorsopathies). Treatment of dorsalgia includes fighting acute bouts of pain and supporting, preventive treatment during the inter-attack period. The earlier treatment is initiated and the adequate analgesic effect is achieved more quickly, the less likely the chronic pain is and the overall prognosis is better. Perspective in terms of therapy of pain syndrome is the drug group of selective activators of neuronal potassium channels – flupirtine. Due to the unique mechanism of action, flupirtine opens a number of additional therapeutic possibilities and advantages: the effect on central pain mechanisms and the possibility of preventing chronicity, the muscle relaxant effect in the area of pain, the possibility of neuroprotective action, the absence of a number of side effects characteristic for opioids and nonsteroidal anti-inflammatory drugs.
Key words: back pain, degenerative diseases of the spine, osteochondrosis, dorsopathy, dorsalgia, flupirtine.
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5. Trukhan D.I. Selection of analgetic with back pain through the prism drug safety and comorbidity: in focus flupirtine. Consilium Medicum. 2017; 9: 22–9. [in Russian]
6. Harirforoosh S, Asghar W, Jamali F. Adverse Effects of Nonsteroidal Antiinflammatory Drugs: An Update of Gastrointestinal, Cardiovascular and Renal Complications. J Pharm Pharm Sci 2013; 5: 821–47.
7. Thomsen R, Riis A, Christensen S et al. Outcome of peptic ulcer bleeding among users of traditional non-steroidal anti-inflammatory drugs and selective cyclo-oxygenase-2 inhibitors. Aliment Pharmacol Ther 2006; 10: 1431–8.
8. Antman EM, Bennett JS, Daugherty A et al. Use of nonsteroidal antiinflammatory drugs.An Update for Clinicians. A Scientific Statement from the American Heart Association. Circulation 2007; 115: 1634–42.
9. Bhatt DL, Scheiman J, Abraham NS et al. ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use AReport of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 2008; 118: 1894–909.
10. Lanza FL, Chan FK, Quigley EM. Guidelines for Prevention of NSAID-Related Ulcer Complications. Am J Gastroenterol 2009; 104: 728–38.
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17. Mamdani M, Juurlink DN, Lee DS et al. Cyclo-oxygenase-2 inhibitors versus non-selective non-steroidal antiinflammatory drugs and congestive heart failure outcomes in elderly patients: a population-based cohort study. Lancet 2004; 363: 1751–6.
18. Sowers JR, White WB, Pitt B et al. The Effects of cyclooxygenase-2 inhibitors and nonsteroidal antiinflammatory therapy on 24-hour blood pressure in patients with hypertension, osteoarthritis, and type 2 diabetes mellitus. Arch Intern Med 2005; 165: 161–8.
19. Aw T-J, Haas SJ, Liew D, Krum H. Meta-analysis of cyclooxygenase-2 inhibitors and their effects on blood pressure. Arch Intern Med 2005; 165: 490–6.
20. Fitzgerald GA. Coxibs and cardiovascular disease. N Engl J Med 2004; 351: 1709–11.
21. Hermann M, Camici G, Fratton A et al. Differential effects of selective cyclooxygenase-2 inhibitors on endothelial function in salt-induced hypertension. Circulation 2003; 108: 2308–11.
22. Zhang J, Ding EL, Song Y. Adverse effects of cyclooxygenase 2 inhibitors on renal and arrhythmia events: meta-analysis of randomized trials. JAMA 2006; 296: 1619–32.
23. Bresalier RS, Sandler RS, Quan H et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 2005; 352: 1092–102.
24. Solomon SD, McMurray JJ, Pfeffer MA et al. Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. N Engl J Med 2005; 352: 1071–80.
25. Graham DJ, Campen D, Hui R et al. Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal antiinflammatory drugs: nested case-control study. Lancet 2005; 365: 475–81.
26. Nussmeier NA, Whelton AA, Brown MT et al. Complications of the COX-2 inhibitors parecoxib and valdecoxib after cardiac surgery. N Engl J Med 2005; 352: 1081–91.
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Авторы
А.А.Пилипович
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2 aapilipovich@mail.ru
________________________________________________
A.A.Pilipovich
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2 aapilipovich@mail.ru