Dissatisfaction with management of musculoskeletal pain: A global problem and methods of its solution

A E Karateev

doi:10.14412/1996-7012-2017-3-4-13

Abstract

Effective control of musculoskeletal pain (MSP) is one of the main tasks of medical care for the most common rheumatic diseases, such as osteoarthritis (OA) and non-specific back pain (NSBP). Epidemiological surveys have shown that a substantial proportion (about 40–50%) of patients consider their assigned treatment to be ineffective and are dissatisfied with its results. The reasons for this are a phenotypic diversity of MSP, individual responses to analgesic drugs, and comorbidities (particularly metabolic disorders and depression). Placebo-controlled trials have demonstrated that monotherapy with the most popular drugs (non-steroidal anti-inflammatory drugs (NSAIDs), opioids, local glucocorticoid injections, duloxetine, etc.) for the treatment of OA and NSBP provides significant pain relief (>50%) in only nearly one-half of patients. This necessitates comprehensive and individualized patient therapy aimed at different components of the pathogenesis of pain. The first step in the treatment of MSP should be the rational use of NSAIDs. Nimesulide that has a favorable combination of efficacy, good tolerability, and an acceptable cost may be considered as the drug of choice. The important element of treatment for chronic MSP is also the use of slow-acting anti-inflammatory drugs, such as diacerein.

Highlights

Dissatisfaction with management of musculoskeletal pain: A global problem and methods of its solution Karateev A.E
Epidemiological surveys have shown that a substantial proportion of patients consider their assigned treatment to be ineffective and are dissatisfied with its results. The reasons for this are a phenotypic diversity of musculoskeletal pain (MSP), individual responses to analgesic drugs, and comorbidities
Placebo-controlled trials have demonstrated that monotherapy with the most popular drugs (non-steroidal anti-inflammatory drugs (NSAIDs), opioids, local glucocorticoid injections, duloxetine, etc.) for the treatment of OA and non-specific back pain (NSBP) provides significant pain relief (>50%) in only nearly one-half of patients

Summary

Introduction

Dissatisfaction with management of musculoskeletal pain: A global problem and methods of its solution Karateev A.E. Placebo-controlled trials have demonstrated that monotherapy with the most popular drugs (non-steroidal anti-inflammatory drugs (NSAIDs), opioids, local glucocorticoid injections, duloxetine, etc.) for the treatment of OA and NSBP provides significant pain relief (>50%) in only nearly one-half of patients. Всегда следует искать причину болезни (например, если ее развитие вызвано инфекционным агентом), а когда это невозможно (как в подавляющем большинстве случаев при хронических заболеваниях), четко выделить основные звенья ее патогенеза.

Results

Conclusion