Дорсалгия – один из наиболее распространенных скелетно-мышечных синдромов. Часто дорсалгия развивается у пациентов старших возрастных групп с полиморбидностью, требующей назначения большого числа лекарственных препаратов. В этих условиях выбор эффективной и безопасной терапии представляет собой сложную проблему. Рассматриваются особенности ведения пациента, страдающего дорсалгией с сопутствующими заболеваниями, риски развития осложнений терапии, возможности обеспечения безопасности лечения, в частности за счет применения комбинированной терапии.
Dorsalgia is one of the most common skeletal muscle syndromes. Dorsalgia often develops in patients of older age groups with polymorbidity that requires the appointment of a large number of medications. In these conditions, the choice of effective and safe therapy is a difficult problem. Discusses management of a patient suffering dorsalgia with comorbidities, the risks of complications of therapy, possible safety treatment, in particular, through the use of combination therapy.
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3. Ita M, Zhang S, Holsgrove T. The Physiological Basis of Cervical Facet-Mediated Persistent Pain: Basic Science and Clinical Challenges. J Orthop Sports Phys Ther. 2017 Jul;47(7):45061. doi: 10.2519/jospt.2017.7255
4. Tsuji T, Matsudaira K, Sato H, Vietri J. Association between presenteeism and health-related quality of life among Japanese adults with chronic lower back pain: a retrospective observational study. BMJ Open. 2018;8(6):e021160. doi: 10.1136/bmjopen-2017-021160
5. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017; 389:736-47. doi: 10.1016/S0140-6736(16)30970-9
6. Bhala N, Emberson J, Merhi A, et al. Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials Lancet. 2013 Aug 31;382(9894):769-79. doi: 10.1016/S0140-6736(13)60900-9
7. Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011 Jan 11;342:c7086. doi: 10.1136/bmj.c7086.
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9. Franceschi F, Saviano L, Petruzziello C, et al. Safety and efficacy of low doses of diclofenac on acute pain in the emergency setting. Eur Rev Med Pharm Sci. 2016;20:4401-8.
10. Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017;357:j1909. doi: 10.1136/bmj.j1909
11. Minuz P, Fumagalli L, Gaino S, et al. Rapid stimulation of tyrosine phosphorylation signals downstream of G-protein-coupled receptors for thromboxane A2 in human platelets. Biochem J. 2006;400:127-34. doi: 10.1042/BJ20061015
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13. Schuijt M, Huntjens-Fleuren H, De Metz M, Vollaard E. The interaction of ibuprofen and diclofenac with aspirin in healthy volunteers. Br
J Pharmacol. 2009;157:931-4. doi: 10.1111/j.1476-5381.2009.00243.x
14. McDowell LR. Vitamins in Animal and Human Nutrition, John Wiley&Sons, 2008.
15. Banerjeeand R, Ragsdale S. The many faces of vitamin B12: catalysis by cobalamin-dependent enzymes. Ann Rev Biochem. 2003;72:209-47. doi: 10.1146/annurev.biochem.72.121801.161828
16. Sun Y, Lai MS, Lu CJ. Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurol Taiwanica. 2005;14(2):48-54.
17. Mizukami H, Ogasawara S, Yamagishi S. et al. Methylcobalamin Effects on Diabetic Neuropathy and Nerve Protein Kinase C in Rats. Eur J Clin Invest. 2011 Apr;41(4):442-50. doi: 10.1111/j.1365-2362.2010.02430.x
18. Sonobe M, Yasuda H, Hatanaka I, et al. Methylcobalamin Improves Nerve Conduction in Streptozotocin-Diabetic Rats Without Affecting Sorbitol and Myo-Inositol Contents of Sciatic Nerve. Horm Metab Res. 1988 Nov;20(11):717-8. doi: 10.1055/s-2007-1010925
19. Watanabe T, Kaji R, Oka N, et al. Ultrahigh dose methylcobalamin promotes nerve regeneration in experimental acrylamide neuropathy. J Neurol Sci. 1994;122(2):140-3. doi: 10.1016/0022-510x(94)90290-9
20. Okada K, Tanaka H, Temporin K, et al. Methylcobalamin increases Erk1/2 and Aktactivities through the methylation cycle and promotes nerve regeneration in a rat sciatic nerve injury model. Exp Neurol. 2010;222(2):191-203. doi: 10.1016/j.expneurol.2009.12.017
21. Jacobs A, Cheng D. Management of diabetic small fiber neuropathy with combination L-methylfolate, methylcobalamin, and pyridoxal 5`-phosphate. Rev Neurol Dis. 2011;8(1-2):39-47.
22. Mahajan A, Sapehia D, Thakur S, et al. Effect of imbalance in folate and vitamin B12 in maternal/parental diet on global methylation and regulatory miRNAs. Sci Rep. 2019 Nov 26;9(1):17602. doi: 10.1038/s41598-019-54070-9
23. Abdoulaye B. Metabolic and structural role of thiamine in nervous tissues. 2008 Nov;28(7):923-31. doi: 10.1007/s10571-008-9297-7
24. Aleshin VA, Mkrtchyan GV, Bunik VI. Mechanisms of Non-coenzyme Action of Thiamine. Biochemistry (Mosc). 2019 Aug;84(8):829-50. doi: 10.1134/S0006297919080017
25. Nardone R, Holler Y, Storti M, et al. Thiamine deficiency induced neurochemical, neuroanatomical, and neuropsychological alterations: A reappraisal. Sci World J. 2013;2013:309143. doi: 10.1155/2013/309143
26. Shible A, Ramadurai D, Gergen D, Reynol M. Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke’s Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature. Am J Case Rep. 2019;20:330-4. doi: 10.12659/AJCR.914051
27. Morava E. Guidelines on homocystinurias and methylation defects: a harmonized approach to diagnosis and management. J Inherit Metab Dis. 2017 Jan;40(1):1-2. doi: 10.1007/s10545-016-9998-x
28. Cetin E, Civelek S, Andican G, et al. Plasma AGE-peptides and C-peptide in early-stage diabetic nephropathy patients on thiamine and pyridoxine therapy. Minerva Med. 2013 Feb;104(1):93-101.
29. Nix W, Zirwes R, Bangert V, et al. Vitamin B status in patients with type 2 diabetes mellitus with and without incipient nephropathy. Diabetes Res Clin Pract. 2014;107(1):157-65. doi: 10.1016/j.diabres.2014.09.058
30. Van der Watt JJ, Harrison T, Benatar M, Heckmann J. Polyneuropathy, anti-tuberculosis treatment and the role of pyridoxine in the HIV-AIDS era. Int J Tuberc Lung Dis. 2011 Jun;15(6):722-8. doi: 10.5588/ijtld.10.0284 doi:10.5588/ijtld.10.0284
31. Panjawatanan P, Charoenkwan P, Katanyuwong K, Choeyprasert W. Vincristine-induced polyneuropathy in a child with stage I Wilms' tumour presenting with unilateral abducens nerve palsy. BMJ Case Rep. 2014 Jun 25;2014:bcr2014204524. doi: 10.1136/bcr-2014-204524
32. Vrolijk F, Opperhuizen A, Jansen H, et al. The vitamin B6 paradox – Supplementation with high concentrations of pyridoxine leads to decreased vitamin B6 function. Toxicol Vitro. 2017 Oct;44:206-12. doi: 10.1016/j.tiv.2017.07.009
33. Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAiDs. Therapeutics and Clinical Risk Management. 2015:11:1061-75. doi: 10.2147/TCRM.S79135
34. Szeto C-C, Sugano K, Wang J-G, et al. Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/
APSDE/APSH/APSN/PoA recommendations. Gut. 2020;0:1-13. doi: 10.1136/gutjnl-2019-319300
35. Cybulski M, Cybulski L, Krajewska-Kulak E, et al. Preferences and attitudes of older adults of Bialystok, Poland toward the use of over-the counter drugs. Clinical Interventions in Aging. 2018;13:623-32. doi: 10.2147/CIA.S158501
36. Talaei A, Siavash M, Majidi H, Chehrei A. Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy. Int J Food Sci Nutr. 2009;60(S5):71-6. doi: 10.1080/09637480802406153
37. Mibielli M, Geller M, Cohen J, et al. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: The DOLOR study. Curr Med Res Opin. 2009;25(11):2589-99. doi: 10.3111/13696990903246911
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39. Deng X-T, Han Y, Liu W-T, Song X-J. B Vitamins potentiate acute morphine antinociception and attenuate the development of tolerance to chronic morphine in mice. Pain Med. 2017;18(10):1961-74. doi: 10.1093/pm/pnw358
40. Calderon-Ospina C-A, Nava-Mesa MO, Ariza C. Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain Management: Systematic Review and Meta-analysis. Pain Med. 2020 Apr;21(4):766-81. doi: 10.1093/pm/pnz216
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________________________________________________
1. Jin Z, Wang D, Zhang H, et al. Incidence trend of five common musculoskeletal disorders from 1990 to 2017 at the global, regional and national level: results from the global burden of disease study 2017. 2020 Aug;79(8):1014-22. doi: 10.1136/annrheumdis-2020-217050
2. Parfenov VA, Yakhno NN, Davydov OS, et al. Chronic non-specific (musculoskeletal) lumbar pain. Recommendations of the Russian Society for the Study of Pain (ROIB). Nevrologiya, neyropsikhiatriya, psikhosomatika. 2019;11 (Spetsvyp. №2):7-16 (In Russ.) doi: 10.14412/2074-2711-2019-2S-7-16
3. Ita M, Zhang S, Holsgrove T. The Physiological Basis of Cervical Facet-Mediated Persistent Pain: Basic Science and Clinical Challenges. J Orthop Sports Phys Ther. 2017 Jul;47(7):45061. doi: 10.2519/jospt.2017.7255
4. Tsuji T, Matsudaira K, Sato H, Vietri J. Association between presenteeism and health-related quality of life among Japanese adults with chronic lower back pain: a retrospective observational study. BMJ Open. 2018;8(6):e021160. doi: 10.1136/bmjopen-2017-021160
5. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017; 389:736-47. doi: 10.1016/S0140-6736(16)30970-9
6. Bhala N, Emberson J, Merhi A, et al. Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials Lancet. 2013 Aug 31;382(9894):769-79. doi: 10.1016/S0140-6736(13)60900-9
7. Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011 Jan 11;342:c7086. doi: 10.1136/bmj.c7086.
8. European Medicines Agency. Assessment report for diclofenac containing medicinal products (systemic formulations). 25 September 2013. http://www.ema.europa. eu/docs/en_GB/document_library/Referrals_document/Diclofenaccontaining_medicinal_products/Recommendation_provided_by_Pharmacovigilance_Risk_Assessment_Committee/WC500155693.pdf (1 April 2015)
9. Franceschi F, Saviano L, Petruzziello C, et al. Safety and efficacy of low doses of diclofenac on acute pain in the emergency setting. Eur Rev Med Pharm Sci. 2016;20:4401-8.
10. Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017;357:j1909. doi: 10.1136/bmj.j1909
11. Minuz P, Fumagalli L, Gaino S, et al. Rapid stimulation of tyrosine phosphorylation signals downstream of G-protein-coupled receptors for thromboxane A2 in human platelets. Biochem J. 2006;400:127-34. doi: 10.1042/BJ20061015
12. Catella-Lawson F, Reilly M, Kapoor S, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001 Dec 20;345(25):1809-17. doi: 10.1056/NEJMoa003199
13. Schuijt M, Huntjens-Fleuren H, De Metz M, Vollaard E. The interaction of ibuprofen and diclofenac with aspirin in healthy volunteers. Br
J Pharmacol. 2009;157:931-4. doi: 10.1111/j.1476-5381.2009.00243.x
14. McDowell LR. Vitamins in Animal and Human Nutrition, John Wiley&Sons, 2008.
15. Banerjeeand R, Ragsdale S. The many faces of vitamin B12: catalysis by cobalamin-dependent enzymes. Ann Rev Biochem. 2003;72:209-47. doi: 10.1146/annurev.biochem.72.121801.161828
16. Sun Y, Lai MS, Lu CJ. Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurol Taiwanica. 2005;14(2):48-54.
17. Mizukami H, Ogasawara S, Yamagishi S. et al. Methylcobalamin Effects on Diabetic Neuropathy and Nerve Protein Kinase C in Rats. Eur J Clin Invest. 2011 Apr;41(4):442-50. doi: 10.1111/j.1365-2362.2010.02430.x
18. Sonobe M, Yasuda H, Hatanaka I, et al. Methylcobalamin Improves Nerve Conduction in Streptozotocin-Diabetic Rats Without Affecting Sorbitol and Myo-Inositol Contents of Sciatic Nerve. Horm Metab Res. 1988 Nov;20(11):717-8. doi: 10.1055/s-2007-1010925
19. Watanabe T, Kaji R, Oka N, et al. Ultrahigh dose methylcobalamin promotes nerve regeneration in experimental acrylamide neuropathy. J Neurol Sci. 1994;122(2):140-3. doi: 10.1016/0022-510x(94)90290-9
20. Okada K, Tanaka H, Temporin K, et al. Methylcobalamin increases Erk1/2 and Aktactivities through the methylation cycle and promotes nerve regeneration in a rat sciatic nerve injury model. Exp Neurol. 2010;222(2):191-203. doi: 10.1016/j.expneurol.2009.12.017
21. Jacobs A, Cheng D. Management of diabetic small fiber neuropathy with combination L-methylfolate, methylcobalamin, and pyridoxal 5`-phosphate. Rev Neurol Dis. 2011;8(1-2):39-47.
22. Mahajan A, Sapehia D, Thakur S, et al. Effect of imbalance in folate and vitamin B12 in maternal/parental diet on global methylation and regulatory miRNAs. Sci Rep. 2019 Nov 26;9(1):17602. doi: 10.1038/s41598-019-54070-9
23. Abdoulaye B. Metabolic and structural role of thiamine in nervous tissues. 2008 Nov;28(7):923-31. doi: 10.1007/s10571-008-9297-7
24. Aleshin VA, Mkrtchyan GV, Bunik VI. Mechanisms of Non-coenzyme Action of Thiamine. Biochemistry (Mosc). 2019 Aug;84(8):829-50. doi: 10.1134/S0006297919080017
25. Nardone R, Holler Y, Storti M, et al. Thiamine deficiency induced neurochemical, neuroanatomical, and neuropsychological alterations: A reappraisal. Sci World J. 2013;2013:309143. doi: 10.1155/2013/309143
26. Shible A, Ramadurai D, Gergen D, Reynol M. Dry Beriberi Due to Thiamine Deficiency Associated with Peripheral Neuropathy and Wernicke’s Encephalopathy Mimicking Guillain-Barré syndrome: A Case Report and Review of the Literature. Am J Case Rep. 2019;20:330-4. doi: 10.12659/AJCR.914051
27. Morava E. Guidelines on homocystinurias and methylation defects: a harmonized approach to diagnosis and management. J Inherit Metab Dis. 2017 Jan;40(1):1-2. doi: 10.1007/s10545-016-9998-x
28. Cetin E, Civelek S, Andican G, et al. Plasma AGE-peptides and C-peptide in early-stage diabetic nephropathy patients on thiamine and pyridoxine therapy. Minerva Med. 2013 Feb;104(1):93-101.
29. Nix W, Zirwes R, Bangert V, et al. Vitamin B status in patients with type 2 diabetes mellitus with and without incipient nephropathy. Diabetes Res Clin Pract. 2014;107(1):157-65. doi: 10.1016/j.diabres.2014.09.058
30. Van der Watt JJ, Harrison T, Benatar M, Heckmann J. Polyneuropathy, anti-tuberculosis treatment and the role of pyridoxine in the HIV-AIDS era. Int J Tuberc Lung Dis. 2011 Jun;15(6):722-8. doi: 10.5588/ijtld.10.0284 doi:10.5588/ijtld.10.0284
31. Panjawatanan P, Charoenkwan P, Katanyuwong K, Choeyprasert W. Vincristine-induced polyneuropathy in a child with stage I Wilms' tumour presenting with unilateral abducens nerve palsy. BMJ Case Rep. 2014 Jun 25;2014:bcr2014204524. doi: 10.1136/bcr-2014-204524
32. Vrolijk F, Opperhuizen A, Jansen H, et al. The vitamin B6 paradox – Supplementation with high concentrations of pyridoxine leads to decreased vitamin B6 function. Toxicol Vitro. 2017 Oct;44:206-12. doi: 10.1016/j.tiv.2017.07.009
33. Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAiDs. Therapeutics and Clinical Risk Management. 2015:11:1061-75. doi: 10.2147/TCRM.S79135
34. Szeto C-C, Sugano K, Wang J-G, et al. Non-steroidal anti-inflammatory drug (NSAID) therapy in patients with hypertension, cardiovascular, renal or gastrointestinal comorbidities: joint APAGE/APLAR/
APSDE/APSH/APSN/PoA recommendations. Gut. 2020;0:1-13. doi: 10.1136/gutjnl-2019-319300
35. Cybulski M, Cybulski L, Krajewska-Kulak E, et al. Preferences and attitudes of older adults of Bialystok, Poland toward the use of over-the counter drugs. Clinical Interventions in Aging. 2018;13:623-32. doi: 10.2147/CIA.S158501
36. Talaei A, Siavash M, Majidi H, Chehrei A. Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy. Int J Food Sci Nutr. 2009;60(S5):71-6. doi: 10.1080/09637480802406153
37. Mibielli M, Geller M, Cohen J, et al. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: The DOLOR study. Curr Med Res Opin. 2009;25(11):2589-99. doi: 10.3111/13696990903246911
38. Kamchatnov PR. Improving the effectiveness and safety of treatment of patients with lumbar pain. Journal of neurology and psychiatry named after SS. Korsakov. 2016;116(10): 28-33 (In Russ.) doi: 10.17116/jnevro201611610128-33
39. Deng X-T, Han Y, Liu W-T, Song X-J. B Vitamins potentiate acute morphine antinociception and attenuate the development of tolerance to chronic morphine in mice. Pain Med. 2017;18(10):1961-74. doi: 10.1093/pm/pnw358
40. Calderon-Ospina C-A, Nava-Mesa MO, Ariza C. Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain Management: Systematic Review and Meta-analysis. Pain Med. 2020 Apr;21(4):766-81. doi: 10.1093/pm/pnz216
41. Manusharova RA, Cherkezov DI. Application of Neuromultivit in diabetic peripheral polyneuropathy. Med. Sovet. 2011;1-2:68-71 (In Russ.)
42. Kurushina OV., Barulin AE. Polyneuropathies in somatic diseases: the role of a neurologist in diagnosis and treatment. RMZh. 2013;36:45-9 (In Russ.)
43. Boyko AN, Batysheva TT, Kamchatnov PR, et al. Neurodiclovit: the possibility of use in patients with back pain. Farmateka. 2010;7(201):63-9 (In Russ.)
44. Solov'eva EYu. Therapy for back pain. Neurology, neuropsychiatry, psychosomatics. 2012;2:96-100 (In Russ.) doi: 10.14412/2074-2711-2012-393
Авторы
П.Р. Камчатнов1, Б.А. Абусуева2, С.Б. Ханмурзаева2, Н.Б. Ханмурзаева2
1 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Дагестанский государственный медицинский университет» Минздрава России, Махачкала, Россия