Contemporary approaches to diagnostics and treatment of nociceptive primary musculoskeletal pain
A. N. Barinov,
M. S. Leontyeva,
Y. B. Telysheva,
E. V. Emikh,
E. V. Yakovleva,
E. V. Parkhomenko,
A. A. Khalimova https://doi.org/10.33667/2078-5631-2023-2-12-18
Abstract
This article discusses contemporary approaches to multimodal, NSAID-sparing management of primary musculoskeletal pain. Despite the scientific advances, musculoskeletal pain remains extremely challenging to manage clinically. While the number of potential treatment targets has grown substantially and a strong case has been made for a mechanism-based and individualized approach to pain therapy, arguably clinicians are not much more advanced now in their capacity to either diagnose or effectively treat patients with musculoskeletal pain. The International Association for the Study of Pain (IASP) pain taxonomy includes pain mechanisms as one of the 3 dimensions that need to be considered when making a diagnostic classification for the concurrent use of separate therapeutic interventions with various mechanisms of action aimed at different pain mechanisms. Combination of shock-wave therapy with topical NSAID tenoxicam is more effective in primary musculoskeletal pain treatment.
About the Authors
A. N. Barinov
Group of companies ‘MEDSI’
Russian Federation
Russian Federation
Barinov Aleksey N., PhD Med, head of Dept of Neurology and Psychotherapy
Moscow
M. S. Leontyeva
Group of companies ‘MEDSI’; I. M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Leontyeva Marina S., neurologist, post-graduate student of Dept of Nervous Diseases and Neurosurgery
Moscow
Y. B. Telysheva
Group of companies ‘MEDSI’
Russian Federation
Russian Federation
Telysheva Yulia B., PhD Med, neurologist
Moscow
E. V. Emikh
Group of companies ‘MEDSI’
Russian Federation
Russian Federation
Emikh Elena V., neurologist, doctor of ultrasound diagnostics, head of Centre for Chronic Pain
Moscow
E. V. Yakovleva
I. M. Sechenov First Moscow State Medical University (Sechenov University); Altai State Medical University
Russian Federation
Russian Federation
Yakovleva Evgenia V., neurologist, post-graduate student, physiotherapist of Clinic of Dr. Shishonin
Moscow
E. V. Parkhomenko
Altai State Medical University
Russian Federation
Russian Federation
Parkhomenko Ekaterina V., PhD Med, associate professor at Dept of Neurology and Neurosurgery
Barnaul
A. A. Khalimova
Prima Medical Group Medical Centre
Kazakhstan
Kazakhstan
Khalimova Asiya A., neurologist
Almaty
References
1. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 386 (9995): 743–800. DOI: 10.1016/S0140–6736(15)60692–4.
2. Raja SN, Carr DB, Cohen M. et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020: 10.1097. DOI: 10.1097/j.pain.0000000000001939 (online ahead of print).
3. Cohen K. M., Baron R. et al. Do we need a third mechanistic descriptor for chronic pain states? Pain. 2016; 157: 1382–1386.
4. Treede R. D. The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain Rep. 2018; 3(2): e643. DOI: 10.1097/PR9.0000000000000643.
5. Рожков Д. О., Баринов А. Н. Диагностика и лечение ноципластической скелетно-мышечной боли. Медицинский алфавит. 2018; 27 (3): 33–40. Barinov A. N., Rozhkov D. O. Diagnostics and treatment of nociplastic musculoskeletal pain. Medical Alphabet. 2018; 27 (3): 33–40.
6. Рожков Д. О., Зиновьева О. Е., Вихлянцев И. М. и др. Вопросы оптимизации ведения пациента с болью в спине. Медицинский совет. 2019; (18): 43–50. DOI: 10.21518/2079–701X‑2019–18–43–50. Rozhkov D. O., Zinov’yeva O.E., Vikhlyantsev I. M. et al. Optimization of the management of a patient with a backache. Medical Advice. 2019; (18): 43–50. DOI: 10.21518/2079–701X‑2019–18–43–50.
7. Рожков Д. О., Зиновьева О. Е., Баринов А. Н. и др. Миофасциальный болевой синдром у пациенток с хронической неспецифической болью в спине: вопросы диагностики и лечения. Неврология, нейропсихиатрия, психосоматика. 2020; 12 (2): 57–63.Rozhkov D. O., Zinov’yeva O.E., Barinov A. N. et al. Myofascial pain syndrome in female patients with chronic nonspecific back pain: diagnosis and treatment. Neurology, Neuropsychiatry, Psychosomatics. 2020; 12 (2): 57–63.
8. Pergolizzi J., Ahlbeck K., Aldington D. et al. The chronic pain conundrum: should we CHANGE from relying on past history to assessing prognostic factors? Curr. Med. Res. Opin. 2012; 28(2): 249–256. DOI: 10.1185/03007995.2011.651525.
9. Shah JP, Thaker N, Heimur J. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R. 2015 Jul; 7(7): 746–61. DOI: 10.1016/j. pmrj.2015.01.024. Epub 2015 Feb 24.
10. Chiarotto A, Clijsen R, Fernandez-de-las-Penas C & Barbero M (2016). Prevalence of Myofascial Trigger Points in Spinal Disorders: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 97 (2), 316–337. DOI: 10.1016/j.apmr.2015.09.021.
11. Chou R, Deyo R, Friedly J, et al. Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017, 4; 166 (7): 480–492.
12. Qaseem A, Wilt TJ, McLean RL, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2017; 166 (7): 514–530.
13. Насонов ЕЛ, Яхно НН, Каратеев АЕ и др. Общие принципы лечения скелетно-мышечной боли: междисциплинарный консенсус. Научно-практическая ревматология. 2016; 54 (3): 247–65. Nasonov E. L., Yakhno N. N., Karateev A. E. et al. General principles of treatment for musculoskeletal pain: interdisciplinary consensus. Scientific and Practical Rheumatology. 2016; 54 (3): 247–65.
14. Xu S, Rouzer CA, Marnett LJ. Oxicams, a class of nonsteroidal anti-inflammatory drugs and beyond. IUBMB Life. 2014; 66 (12): 803–811. DOI: 10.1002/iub.1334.
15. Кукес И. В., Лунегов Т. Д. Клиническое значение ряда фармакодинамических и фармакокинетических параметров некоторых НПВП. Используем ли мы их при планировании фармакотерапии? Лекарственные средства и рациональная фармакотерапия. 2022; 2 (3): 24–33. DOI: 10.56356/23070749_2022_03_24. Kukes I. V., Lunegov T. D. Clinical significance of pharmacodynamic and pharmacokinetic parameters of a number of NSAIDs. Do we use them when planning pharmacotherapy? Drugs and rational pharmacotherapy. 2022; 2 (3): 24–33. DOI: 10.56356/23070749_2022_03_24.
16. Теноксикам [интернет]. РЛС®. 2022. Доступ по ссылке: https://www.rlsnet.ru/active-substance/tenoksikam-981 Tenoxicam [Internet]. RLS®. 2020. https://www.rlsnet.ru/active-substance/tenoksikam-981.
17. Инструкция по медицинскому применению лекарственного препарата теноксикам (артоксан) 20 мг, в форме таблеток, покрытых пленочной оболочкой, РУ № 125049. Доступ по ссылке: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=e404a33a-268c-406b-b75c-dccdef8a7c92_16.07.2022 Instructions for use of the drug tenoxicam (artoxan) 20 mg, in the form of film-coated tablets, RU № 125049. https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=e404a33a-268c-406b-b75c-dccdef8a7c92_16.07.2022.
18. Tenoxicam [интернет]. Go.drugbank.com. 2022. Доступ по ссылке: https://go.drugbank.com/drugs/DB00469Tenoxicam [Internet]. go.drugbank.com. 2022. Access via the link: https:// go.drugbank.com/drugs/DB 00469
19. Государственный реестр лекарственных средств [интернет]. Grls. rosminzdrav.ru. 2022. Доступ по ссылке: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=7abbbb4c-dede-4f9e-a2b1-bad050cf55b5 State Register of Medicines [Internet]. Grls.rosminzdrav.ru. 2022. https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=7abbbb4c-dede-4f9e-a2b1-bad050cf55b5.
20. Ших Е. В., Сереброва С. Ю., и др. Клиническая фармакология препарата Артоксан Издательство АНО «Международная ассоциация клинических фармакологов и фармацевтов», 2019. Shih E. B., Serebrova S. Y. et al. Clinical pharmacology of the drug Artoxan. Publishing house ANO ‘International association of clinical pharmacologosts and pharmacists’, 2019.
21. van Antwerpen P, Nève J. In vitro comparative assessment of the scavenging activity against three reactive oxygen species of non-steroidal anti-inflammatory drugs from the oxicam and sulfoanilide families. Eur J Pharmacol 2004; 496 (13): 55–61.
22. Ferrari GV, Natera J, Paulina Monta ña M Scavenging of photogenerated ROS by Oxicams. Possible biological and environmental implications. J Photochem Photobiol B 2015; 153: 233–9.
23. Ozgocmen S., Ardicoglu O., Erdogan H., Fadillioglu E., Gudul H. In vivo effect of celecoxib and tenoxicam on oxidant/ anti-oxidant status of patients with knee osteoarthritis. Ann Clin Lab Sci. 2005 Spring;35(2):137–43. PMID: 15943176.
24. Воробьева О. В. Роль нестероидных противовоспалительных препаратов в лечении болевых синдромов в практике врача-невролога РМЖ. № 25 от 16.12.2003, стр. 1410. Vorob'eva O. V. The role of non-steroidal anti-inflammatory drugs in the treatment of pain syndromes in the practice of a neurologist. RMJ. 2003; 25: 1410.
25. E. Vignon, P. Mathieu, P. Louisot, M. Richard In vitro effect of nonsteroidal antiinflammatory drugs on proteoglycanase and collagenase activity in human osteoarthritic cartilage Arthritis and Rheumatism, Vol. 34, No. 10 (October 1991)
26. Страхов М. А. Сочетанная терапия нестероидными противовоспалительными препаратами и медленно действующими хондропротекторами в практике травматолога-ортопеда. Opinion Lider № 8. Травматология и ортопедия. 2018. Strahov M. A. Combined therapy with non-steroidal anti-inflammatory drugs and slow-acting chondroprotectors in the practice of an orthopedic traumatologist. Opinion Lider No. 8. Traumatology and Orthopedics. 2018.
27. Florent Richy NSAIDS, malignancies and GI adverse events: A FAERS analysis. January 2018. DOI: 10.15761/GMO.1000137.
28. Российские клинические рекомендации. Ревматология. Под ред. Е. Л. Насонова. М.: ГЭОТАР-Медиа, 2017. Russian clinical recommendations. Rheumatology. Ed. by E. L. Nasonov. Мoscow: GEOTAR-Media, 2017.
29. Каратеев А. Е., Лила А. М. Локальные формы НПВП: современный взгляд на эффективность и безопасность. РМЖ. Медицинское обозрение. 2019; 11 (II). Karateev A. E., Lila A. M. Local forms of NSAIDs: A modern view on efficacy and safety. RMZH. Medical Review. 2019; 11 (II): 75–80.
30. Страхов М. А., Маремкулов К. К., Особенности мультимодального подхода в терапии болевых синдромов опорно-двигательного аппарата. Opinion Leader 2022 (57): 52–56. Strahov M. A., Maremkulov K. K. Features of a multimodal approach in the treatment of pain syndromes of the musculoskeletal system. Opinion Leader 2022 (57): 52–56.
Review
For citations:
Barinov A.N., Leontyeva M.S., Telysheva Y.B., Emikh E.V., Yakovleva E.V., Parkhomenko E.V., Khalimova A.A. Contemporary approaches to diagnostics and treatment of nociceptive primary musculoskeletal pain. Medical alphabet. 2023;(2):12-18. (In Russ.) https://doi.org/10.33667/2078-5631-2023-2-12-18
Views:
646
Email this article 