medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-35-41-46medalphabet-2359Research ArticleСТОМАТОЛОГИЯDENTISTRYКакое НПВС выбрать при болевом синдроме у полиморбидных пациентов?Which NSAID to choose for treatment of pain syndrome in polymorbid patients?https://orcid.org/0000-0001-7168-3636ПереверзевА. П.PereverzevA. P.

Переверзев Антон Павлович - кандидат медицинских наук, доцент кафедры терапии и полиморбидной патологии.

Москва

Pereverzev Anton P. - PhD Med, associate professor at Dept of Therapy and Polymorbid Pathology.

Moscow

terapia_polimorbid@rmapo.ruФГБОУ ДПО Российская медицинская академия непрерывного профессионального образования Минздрава РоссииРоссияRussian Medical Academy for Continuing Professional EducationRussian Federation202118122021035Практическая гастроэнтерология (3)4146Copyright © Переверзев А.П., 20212021Переверзев А.П.Pereverzev A.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/2359

Полиморбидный пациент – это больной с наличием нескольких синхронно протекающих заболеваний в различных стадиях и фазах своего развития. У пациентов с полиморбидной патологией статистически достоверно почти в 2,5 раза (отношение шансов (OШ) = 2,41; p = 0,01) чаще отмечается болевой синдром, который не только снижает качество их жизни, но и может провоцировать развитие других заболеваний (например, депрессии, артериальной гипертензии и т. д.), что будет способствовать прогрессированию полиморбидности. Лица с распространенным хроническим болевым синдромом имели значительно повышенный риск летального исхода как от всех причин (отношение рисков [ОР] = 1,95; 95 % доверительный интервал [ДИ]: 1,26–3,03), так и от сердечно-сосудистых причин (ОР = 2,72; 95 % ДИ: 1,41–5,26) по сравнению с пациентами без хронической боли. Следовательно, для улучшения прогноза и качества жизни пациента как острую, так и хроническую боль необходимо обязательно лечить с помощью немедикаментозных (лечебная физкультура, тейпирование, виртуальная реальность и т. д.) и медикаментозных средств. Нестероидные противовоспалительные средства (НПВС) являются препаратами первой линии терапии болевого синдрома легкой и умеренной степени тяжести. Рациональный выбор НПВС у пациентов c полиморбидностью может быть затруднен вследствие наличия нозологий, ограничивающих их применение, или состояний, являющихся фактором риска развития осложнений лекарственной терапии. Автор рассматривает основные подходы к выбору оптимального НПВС у полиморбидных пациентов, а также обосновывает эффективность и безопасность применения у данных лиц оригинального мелоксикама (Мовалис®, «Берингер Ингельхайм Интернешнл»).

A polymorbid patient is a patient with several diseases occurring simultaneously at different stages and phases of their development. Patients with polymorbid pathology have a statistically significant almost 2.5 times higher risk (odds ratio [OR] = 2.41; p = 0.01) of pain syndrome and other diseases (for example, depression, arterial hypertension, etc.), which will contribute to the progression of polymorbidity. Individuals with chronic pain have a significantly increased risk of all causes’ death (hazard ratio [HR] = 1.95; 95 % confidence interval [CI]: 1.26–3.03) and cardiovascular causes (RR = 2.72; 95 % CI: 1.41–5.26) compared to patients without chronic pain. Therefore, in order to improve the prognosis and quality of life of the patient, both acute and chronic pain must be treated with non-pharmacological (exercise therapy, taping, virtual reality, etc.) and pharmacological methods. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for mild to moderate pain. The rational choice of NSAIDs in polymorbid patients can be difficult due to the presence of pathologies that limit their use or conditions that are risk factors of complications of drug therapy. In this article, the author present approaches to choosing the optimal NSAID in polymorbid patients, and justify efficacy and safety of administration of original meloxicam in these individuals (Movalis®, Boehringer Ingelheim International).

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