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Острая боль в практике ревматолога
Погожева Е.Ю., Амирджанова В.Н., Каратеев А.Е. Острая боль в практике ревматолога. Consilium Medicum. 2019; 21 (9): 121–124. DOI: 10.26442/20751753.2019.9.190630
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Pogozheva E.Iu., Amirdzhanova V.N., Karateev A.E. Acute pain in rheumatologist’s practice. Consilium Medicum. 2019; 21 (9): 121–124. DOI: 10.26442/20751753.2019.9.190630
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Аннотация
Острая боль является одной из наиболее частых причин обращения пациентов за медицинской помощью, существенно снижает качество жизни, приводит к потере трудоспособности. Важно отметить, что эффективность анальгетической терапии становится для пациента наиболее значимым критерием качества лечения. Успешная анальгетическая терапия позволяет повысить приверженность пациентов лечению, улучшить взаимодействие врача и пациента. В то же время недостаточный контроль острой боли может стать причиной ее хронизации. Среди предикторов перехода острой боли в хроническую следует выделить прежде всего исходно высокую интенсивность боли, недостаточную эффективность лечения, катастрофизацию своего состояния, психологические нарушения (депрессия, тревожность), а также физический труд и избыточную массу тела. Так как воспаление является основным механизмом развития острой и хронической боли, средством 1-й линии анальгетической терапии следует считать нестероидные противовоспалительные препараты (НПВП). В ревматологии использование НПВП показано в качестве симптоматического обезболивающего и противовоспалительного средства при острой и хронической скелетно-мышечной боли, возникшей на фоне заболеваний опорно-двигательного аппарата (остеоартрит, ревматоидный артрит, спондилоартрит), неспецифической боли в спине, метаболических артропатиях, локальном воспалении мягких тканей ревматического характера (тендинит, тендовагинит, бурсит), а при лечении анкилозирующего спондилита НПВП являются основным патогенетическим средством, позволяющим замедлить прогрессирование болезни. При интенсивной острой боли, где скорость наступления обезболивающего эффекта имеет принципиальное значение, оправдано использование внутривенных и внутримышечных инъекций НПВП. Для эффективной помощи пациентам с болевым синдромом необходимо выбирать препарат из группы НПВП, имеющий выраженное терапевтическое действие, быстрое развитие эффекта и хороший профиль безопасности. Такими качествами обладает препарат декскетопрофен (Дексалгин®). В статье рассмотрены данные отечественных и зарубежных исследований, в которых декскетопрофен (Дексалгин®) продемонстрировал свою эффективность в качестве обезболивающей и противовоспалительной терапии многих заболеваний, сопровождающихся скелетно-мышечной болью. К его несомненным преимуществам следует отнести выраженный анальгетический эффект, быстроту наступления терапевтического действия, наличие лекарственных форм для парентерального (внутримышечного и внутривенного) введения, обширный опыт применения препарата.
Ключевые слова: острая боль, нестероидные противовоспалительные препараты, декскетопрофен, Дексалгин, инъекции, эффективность, переносимость.
Ключевые слова: острая боль, нестероидные противовоспалительные препараты, декскетопрофен, Дексалгин, инъекции, эффективность, переносимость.
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Acute pain is one of the most frequent reasons for patients’ presentation that significantly decreases quality of life and results in disability. It is important to notice that analgesic therapy effectiveness becomes the most important criteria of treatment quality for the patient. Successful analgesic therapy allows to increase treatment compliance and to improve communication between the medical practitioner and the patient. At the same time not significant acute pain control may become a reason for its chronification. Among prognostic factors of acute pain chronification special mention should go to baseline pain high intensity, insufficient treatment effectiveness, catastrophizing of the condition by the patient, psychological disorders (depression, anxiety) as well as physical labor and excess body mass. As inflammation is one of the main mechanisms of acute and chronic pain development, non-steroid anti-inflammatory drugs (NSAIDs) should be considered as a first line analgesic therapy. The use of NSAIDs in rheumatology is indicated as a symptomatic analgesic and anti-inflammatory medication in acute and chronic musculoskeletal pain in patients with musculoskeletal system disorders (osteoarthritis, rheumatoid arthritis, and spondylarthritis), non-specific back pain, metabolic arthropathies, local soft tissue inflammation of rheumatologic genesis (tendinitis, tendovaginitis, bursitis), also in treatment of ankylosing spondylitis NSAIDs are the main group of pathogenic medication that allows to slow disease progression. In intensive acute pain treatment where timing of analgesic effect onset is principal, the use of intravenous and intramuscular NSAIDs injections is justified. For effective help to the patients with pain syndrome it is necessary to choose a NSAIDs medication with significant therapeutic effect, rapid effect development and good safety profile. Dexketoprofen (Dexalgin®) has all these qualities. The article describes data fr om Russian and foreign studies wh ere Dexketoprofen (Dexalgin®) was shown to be effective as an analgesic and anti-inflammatory therapy in many disorders associated with musculoskeletal pain. Its doubtless advantages include significant analgesic effect, rapidity of therapeutic effect, availability of dosage forms for parenteral (intramuscular and intravenous) use, and solid experience of use,
Key words: acute pain, non-steroid anti-inflammatory drugs, dexketoprofen, Dexalgin, injections, effectiveness, tolerability.
Key words: acute pain, non-steroid anti-inflammatory drugs, dexketoprofen, Dexalgin, injections, effectiveness, tolerability.
Полный текст
Список литературы
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2. Chua JR, Gibson KA, Pincus T. Pain and other self-report scores in patients with osteoarthritis indicate generally similar disease burden to patients with rheumatoid arthritis. Clin Exp Rheumatol 2017; 35 (Suppl. 107); 5: 88–93.
3. Ten Klooster PM, Veehof MM, Taal E et al. Changes in priorities for improvement in patients with rheumatoid arthritis during 1 year of anti-tumour necrosis factor treatment. Ann Rheum Dis 2007; 66 (11): 1485–90.
4. Althaus A, Arranz Becker O, Moser KH et al. Postoperative pain trajectories and pain chronification-an empirical typology of pain patients. Pain Med 2018; 19 (12): 2536–45.
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7. Blichfeldt-Eckhardt MR, Andersen C, Ording H et al. From acute to chronic pain after thoracic surgery: the significance of different components of the acute pain response. J Pain Res 2018; 11: 1541–8.
8. Lewis GN, Rice DA, McNair PJ, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 2015; 114 (4): 551–61.
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10. Gerhart JI, Burns JW, Bruehl S et al. Variability in negative emotions among individuals with chronic low back pain: relationships with pain and function. Pain 2018; 159 (2): 342–50.
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12. Friedman BW, Gensler S Yoon A et al. Predicting threemonth functional outcomes after an ED visit for acute low back pain. Am J Emerg Med 2017; 35 (2): 299–305.
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[Karateev A.E., Nasonov E.L., Iakhno N.N. et al. Klinicheskie rekomendatsii "Ratsional'noe primenenie nesteroidnykh protivovospalitel'nykh preparatov (NPVP) v klinicheskoi praktike'. Sovrem. revmatologiia. 2015; 9 (1): 4–24 (in Russian).]
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[Clinical recommendations. Rheumatology. Pod red. E.L.Nasonova. Moscow: GEOTAR-Media, 2017; p. 349–55 (in Russian).]
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18. Barbanoj M, Antonijoan R, Gich I. Clinical pharmacokinetics of dexketoprofen. Clin Pharmacokinet 2001; 40 (4): 245–62.
19. Rodríguez MJ, Arbós RM, Amaro SR. Dexketoprofen trometamol: clinical evidence supporting its role as a painkiller. Exp Rev Neurother 2008; 8 (11): 1625–40. DOI: 10.1586/14737175.8.11.1625
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22. Торшин И.Ю., Громова О.А., Федотова Л.Э., Громов А.Н. Сравнительный хемореактомный анализ декскетопрофена, кетопрофена и диклофенака. Неврология, нейропсихиатрия, психосоматика. 2018; 10 (1): 47–54.
[Torshin I.Iu., Gromova O.A., Fedotova L.E., Gromov A.N. Sravnitel'nyi khemoreaktomnyi analiz deksketoprofena, ketoprofena i diklofenaka. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2018; 10 (1): 47–54 (in Russian).]
23. Moore RA, Barden J. Systematic review of dexketoprofen in acute and chronic pain. BMC Clin Pharmacol 2008; 8: 11. DOI: 10.1186/1472-6904-8-11
24. Metscher B, Kübler U, Jahnel-Kracht H. Dexketoprofen-trometamol and tramadol in acute lumbago. Fortschr Med Orig 2001; 118 (4): 147–51.
25. Zippel H, Wagenitz A. A multicentre, randomised, double-blind study comparing the efficacy and tolerability of intramuscular dexketoprofen versus diclofenac in the symptomatic treatment of acute low back pain. Clin Drug Invest 2007; 27 (8): 533–43.
26. Eken C, Serinken M, Elicabuk H et al. Intravenous paracetamol versus dexketoprofen versus morphine in acute mechanical low back pain in the emergency department: a randomised double-blind controlled trial. Emerg Med J 2014; 31 (3): 177-81. DOI: 10.1136/emermed-2012-201670
27. Tunali Y, Akçil EF, Dilmen OK et al. Efficacy of intravenous paracetamol and dexketoprofen on postoperative pain and morphine consumption after a lumbar disk surgery. J Neurosurg Anesthesiol 2013; 25 (2): 143–7. DOI: 10.1097/ANA.0b013e31827464.
28. Demirozogul E, Yilmaz A, Ozen M et al. Intravenous dexketoprofen versus paracetamol in non-traumatic musculoskeletal pain in the emergency department: A randomized clinical trial. Am J Emerg Med 2019. pii: S0735-6757(19)30045-2. DOI: 10.1016/j.ajem.2019.01.040
29. Zippel H, Wagenitz A. Comparison of the efficacy and safety of intravenously administered dexketoprofen trometamol and ketoprofen in the management of pain after orthopaedic surgery: A multicentre, double-blind, randomised, parallel-group clinical trial. Clin Drug Invest 2006; 26 (9): 517–28.
30. Sjövall S, Kokki M, Nokela A et al. Intravenous dexketoprofen induces less injection pain than racemic ketoprofen. J Clin Pharm Ther 2015; 40 (4): 431–5. DOI: 10.1111/jcpt.12284
31. Sivrikoz N, Koltka K, Güresti E et al. Perioperative dexketoprofen or lornoxicam administration for pain management after major orthopedic surgery: a randomized, controlled study. Agri 2014; 26 (1): 23–8. DOI: 10.5505/agri.2014.09821
32. Подчуфарова Е.В. Дексалгин в лечении острых болевых синдромов пояснично-крестцовой локализации. Боль. 2005; 2: 41–4.
[Podchufarova E.V. Deksalgin v lechenii ostrykh bolevykh sindromov poiasnichno-kresttsovoi lokalizatsii. Bol'. 2005; 2: 41–4 (in Russian).]
33. Чичасова Н.В. Новые подходы к купированию острого болевого синдрома в ревматологии и неврологии. Consilium Medicum. 2009; 11 (2): 50–5.
[Chichasova N.V. Novye podkhody k kupirovaniiu ostrogo bolevogo sindroma v revmatologii i nevrologii. Consilium Medicum. 2009; 11 (2): 50–5 (in Russian).]
34. Барулин А.Е., Курушина О.В. Комплексная терапия острой и хронической боли в спине с применением препарата дексалгин. Журн. неврологии и психиатрии им. C.C. Корсакова. 2012; 112 (11): 61–4.
[Barulin A.E., Kurushina O.V. Kompleksnaia terapiia ostroi i khronicheskoi boli v spine s primeneniem preparata deksalgin. Zhurn. nevrologii i psikhiatrii im. C.C. Korsakova. 2012; 112 (11): 61–4 (in Russian).]
35. Carne X, Rios J, Torres F. Postmarketing cohort study to assess the safety profile of oral dexketoprofen trometamol for mild to moderate acute pain treatment in primary care. Methods Find Exp Clin Pharmacol 2009; 31 (8): 533–40.
36. Laporte J, Ibanez L, Vidal X et al. Upper gastrointestinal bleeding associated with the use of NSAIDs. Drug Saf 2004; 27 (6): 411–20.
2. Chua JR, Gibson KA, Pincus T. Pain and other self-report scores in patients with osteoarthritis indicate generally similar disease burden to patients with rheumatoid arthritis. Clin Exp Rheumatol 2017; 35 (Suppl. 107); 5: 88–93.
3. Ten Klooster PM, Veehof MM, Taal E et al. Changes in priorities for improvement in patients with rheumatoid arthritis during 1 year of anti-tumour necrosis factor treatment. Ann Rheum Dis 2007; 66 (11): 1485–90.
4. Althaus A, Arranz Becker O, Moser KH et al. Postoperative pain trajectories and pain chronification-an empirical typology of pain patients. Pain Med 2018; 19 (12): 2536–45.
5. Gilron I, Vandenkerkhof E, Katz J et al. Evaluating the association between acute and chronic pain after surgery: impact of pain measurement methods. Clin J Pain 2017; 33 (7): 588–94.
6. Blichfeldt-Eckhardt MR. From acute to chronic postsurgical pain: the significance of the acute pain response. Dan Med J 2018; 65 (3). ID B5326.
7. Blichfeldt-Eckhardt MR, Andersen C, Ording H et al. From acute to chronic pain after thoracic surgery: the significance of different components of the acute pain response. J Pain Res 2018; 11: 1541–8.
8. Lewis GN, Rice DA, McNair PJ, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 2015; 114 (4): 551–61.
9. Beneciuk JM, Lentz TA, He Y et al. Prediction of persistent musculoskeletal pain at 12 months: a secondary analysis of the optimal screening for prediction of referral and outcome (OSPRO) Validation Cohort Study. Phys Ther 2018; 98 (5): 290–301.
10. Gerhart JI, Burns JW, Bruehl S et al. Variability in negative emotions among individuals with chronic low back pain: relationships with pain and function. Pain 2018; 159 (2): 342–50.
11. Lagersted-Olsen J, Bay H, Jorgensen MB et al. Low back pain patterns over one year among 842 workers in the DPhacto study and predictors for chronicity based on repetitive measurements. BMC Musculoskelet Disord 2016; 17 (1). ID 453.
12. Friedman BW, Gensler S Yoon A et al. Predicting threemonth functional outcomes after an ED visit for acute low back pain. Am J Emerg Med 2017; 35 (2): 299–305.
13. Clark J, Nijs J, Yeowell G, Goodwin PC. What are the predictors of altered central pain modulation in chronic musculoskeletal pain populations? A systematic review. Pain Physician 2017; 20 (6): 487–500.
14. Каратеев А.Е., Насонов Е.Л., Яхно Н.Н. и др. Клинические рекомендации «Рациональное применение нестероидных противовоспалительных препаратов (НПВП) в клинической практике». Соврем. ревматология. 2015; 9 (1): 4–24.
[Karateev A.E., Nasonov E.L., Iakhno N.N. et al. Klinicheskie rekomendatsii "Ratsional'noe primenenie nesteroidnykh protivovospalitel'nykh preparatov (NPVP) v klinicheskoi praktike'. Sovrem. revmatologiia. 2015; 9 (1): 4–24 (in Russian).]
15. Клинические рекомендации. Ревматология. Под ред. Е.Л.Насонова. М.: ГЭОТАР-Медиа, 2017; с. 349–55.
[Clinical recommendations. Rheumatology. Pod red. E.L.Nasonova. Moscow: GEOTAR-Media, 2017; p. 349–55 (in Russian).]
16. Henry D, Lim L, Garcia Rodriguez L et al. Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 1996; 312: 1563–6.
17. Lanas A, Garsia-Rodriguez L, Arroyo M et al. Risk of upper gastrointestinal ulcer bleeding associated with selective COX-2 inhibitors, traditional non-steroidal non-aspirin NSAID, aspirin, and combinations. Gut published online 10 may 2006; DOI: 10.1136/gut.2005.080754.
18. Barbanoj M, Antonijoan R, Gich I. Clinical pharmacokinetics of dexketoprofen. Clin Pharmacokinet 2001; 40 (4): 245–62.
19. Rodríguez MJ, Arbós RM, Amaro SR. Dexketoprofen trometamol: clinical evidence supporting its role as a painkiller. Exp Rev Neurother 2008; 8 (11): 1625–40. DOI: 10.1586/14737175.8.11.1625
20. Walczak JS. Analgesic properties of dexketoprofen trometamol. Pain Manag 2011; 1 (5): 409–16. DOI: 10.2217/pmt.11.42
21. Iohom G, Walsh M, Higgins G, Shorten G. Effect of perioperative administration of dexketoprofen on opioid requirements and inflammatory response following elective hip arthroplasty. Br J Anaesth 2002; 88 (4): 520–6.
22. Торшин И.Ю., Громова О.А., Федотова Л.Э., Громов А.Н. Сравнительный хемореактомный анализ декскетопрофена, кетопрофена и диклофенака. Неврология, нейропсихиатрия, психосоматика. 2018; 10 (1): 47–54.
[Torshin I.Iu., Gromova O.A., Fedotova L.E., Gromov A.N. Sravnitel'nyi khemoreaktomnyi analiz deksketoprofena, ketoprofena i diklofenaka. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2018; 10 (1): 47–54 (in Russian).]
23. Moore RA, Barden J. Systematic review of dexketoprofen in acute and chronic pain. BMC Clin Pharmacol 2008; 8: 11. DOI: 10.1186/1472-6904-8-11
24. Metscher B, Kübler U, Jahnel-Kracht H. Dexketoprofen-trometamol and tramadol in acute lumbago. Fortschr Med Orig 2001; 118 (4): 147–51.
25. Zippel H, Wagenitz A. A multicentre, randomised, double-blind study comparing the efficacy and tolerability of intramuscular dexketoprofen versus diclofenac in the symptomatic treatment of acute low back pain. Clin Drug Invest 2007; 27 (8): 533–43.
26. Eken C, Serinken M, Elicabuk H et al. Intravenous paracetamol versus dexketoprofen versus morphine in acute mechanical low back pain in the emergency department: a randomised double-blind controlled trial. Emerg Med J 2014; 31 (3): 177-81. DOI: 10.1136/emermed-2012-201670
27. Tunali Y, Akçil EF, Dilmen OK et al. Efficacy of intravenous paracetamol and dexketoprofen on postoperative pain and morphine consumption after a lumbar disk surgery. J Neurosurg Anesthesiol 2013; 25 (2): 143–7. DOI: 10.1097/ANA.0b013e31827464.
28. Demirozogul E, Yilmaz A, Ozen M et al. Intravenous dexketoprofen versus paracetamol in non-traumatic musculoskeletal pain in the emergency department: A randomized clinical trial. Am J Emerg Med 2019. pii: S0735-6757(19)30045-2. DOI: 10.1016/j.ajem.2019.01.040
29. Zippel H, Wagenitz A. Comparison of the efficacy and safety of intravenously administered dexketoprofen trometamol and ketoprofen in the management of pain after orthopaedic surgery: A multicentre, double-blind, randomised, parallel-group clinical trial. Clin Drug Invest 2006; 26 (9): 517–28.
30. Sjövall S, Kokki M, Nokela A et al. Intravenous dexketoprofen induces less injection pain than racemic ketoprofen. J Clin Pharm Ther 2015; 40 (4): 431–5. DOI: 10.1111/jcpt.12284
31. Sivrikoz N, Koltka K, Güresti E et al. Perioperative dexketoprofen or lornoxicam administration for pain management after major orthopedic surgery: a randomized, controlled study. Agri 2014; 26 (1): 23–8. DOI: 10.5505/agri.2014.09821
32. Подчуфарова Е.В. Дексалгин в лечении острых болевых синдромов пояснично-крестцовой локализации. Боль. 2005; 2: 41–4.
[Podchufarova E.V. Deksalgin v lechenii ostrykh bolevykh sindromov poiasnichno-kresttsovoi lokalizatsii. Bol'. 2005; 2: 41–4 (in Russian).]
33. Чичасова Н.В. Новые подходы к купированию острого болевого синдрома в ревматологии и неврологии. Consilium Medicum. 2009; 11 (2): 50–5.
[Chichasova N.V. Novye podkhody k kupirovaniiu ostrogo bolevogo sindroma v revmatologii i nevrologii. Consilium Medicum. 2009; 11 (2): 50–5 (in Russian).]
34. Барулин А.Е., Курушина О.В. Комплексная терапия острой и хронической боли в спине с применением препарата дексалгин. Журн. неврологии и психиатрии им. C.C. Корсакова. 2012; 112 (11): 61–4.
[Barulin A.E., Kurushina O.V. Kompleksnaia terapiia ostroi i khronicheskoi boli v spine s primeneniem preparata deksalgin. Zhurn. nevrologii i psikhiatrii im. C.C. Korsakova. 2012; 112 (11): 61–4 (in Russian).]
35. Carne X, Rios J, Torres F. Postmarketing cohort study to assess the safety profile of oral dexketoprofen trometamol for mild to moderate acute pain treatment in primary care. Methods Find Exp Clin Pharmacol 2009; 31 (8): 533–40.
36. Laporte J, Ibanez L, Vidal X et al. Upper gastrointestinal bleeding associated with the use of NSAIDs. Drug Saf 2004; 27 (6): 411–20.
________________________________________________
1. Kahlenberg CA, Nwachukwu BU, McLawhorn AS et al. Patient satisfaction after total knee replacement: a systematic review. HSS J 2018; 14 (2): 192–201.
2. Chua JR, Gibson KA, Pincus T. Pain and other self-report scores in patients with osteoarthritis indicate generally similar disease burden to patients with rheumatoid arthritis. Clin Exp Rheumatol 2017; 35 (Suppl. 107); 5: 88–93.
3. Ten Klooster PM, Veehof MM, Taal E et al. Changes in priorities for improvement in patients with rheumatoid arthritis during 1 year of anti-tumour necrosis factor treatment. Ann Rheum Dis 2007; 66 (11): 1485–90.
4. Althaus A, Arranz Becker O, Moser KH et al. Postoperative pain trajectories and pain chronification-an empirical typology of pain patients. Pain Med 2018; 19 (12): 2536–45.
5. Gilron I, Vandenkerkhof E, Katz J et al. Evaluating the association between acute and chronic pain after surgery: impact of pain measurement methods. Clin J Pain 2017; 33 (7): 588–94.
6. Blichfeldt-Eckhardt MR. From acute to chronic postsurgical pain: the significance of the acute pain response. Dan Med J 2018; 65 (3). ID B5326.
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Авторы
Е.Ю. Погожева*, В.Н. Амирджанова, А.Е. Каратеев
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия
*dr.pogozheva@gmail.com
ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия
*dr.pogozheva@gmail.com
________________________________________________
Elena Iu. Pogozheva*, Vera N. Amirdzhanova, Andrei E. Karateev
Nasonova Research Institute of Rheumatology, Moscow, Russia
*dr.pogozheva@gmail.com
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