Rational Pharmacotherapy in Case of Exacerbation of the Primary Low Back Pain

Abstract

Low back pain (LBP) is one of the most common causes of orthopedic disability in people under 45 years of age. Primary LBP accounts for more than 90 % of all cases. The main objectives of treatment are to slow the progression of the degenerative process, reduce the intensity of inflammation and pain, increase functional activity and quality of life of patients. The solution of the set tasks is impossible without effective complex influence on numerous links of pathogenesis of degenerative-dystrophic and inflammatory process and ensuring safety at treatment.
 The objective: to evaluate the clinical effectiveness of complex conservative treatment of primary LBP with the use of the drug Alsokam (meloxicam) in patients with uncomplicated forms of degenerative-dystrophic lesions of the spine in the period of exacerbation.
 Materials and methods. A non-randomized, prospective comparative clinical study in two parallel groups involved 30 patients with exacerbation of LBP on the background of uncomplicated forms of degenerative-dystrophic lesions of the spine (osteochondrosis, spondyloarthritis). The mean age of patients was 40±7,2 years. There were 12 (40 %) female patients and 18 (60 %) male patients. The main group consisted of 15 patients who were prescribed the drug Alsokam (meloxicam) at a dose of 15 mg 1 time per day intramuscularly for 7 days. The control group consisted of 15 patients who received diclofenac sodium at a traditional daily dose of 75 mg intramuscularly once daily for 7 days during the same treatment period. In both groups, tolperisone 150 mg 3 times a day and B vitamins were also used for 10 15 days. Outcome evaluation parameters included: Visual analog pain scale (VAS), Huskisson; assessment of the patient’s functional status on the Roland-Morris scale (RDQ-24); accounting for side effects and adverse events in the observation groups.
 Results. In both groups, a significant decrease in the intensity of the pain syndrome was observed in the assessment of pain by VAS, but no statistically significant difference was observed between the observation groups (p=0,312). The analysis of the results of the evaluation of RDQ-24 also showed an increase in functional capacity in both groups, but without a significant difference between the groups of clinical observation (p=0,302). Analysis of the number of undesirable side effects in the observation groups showed a significantly lower frequency in patients of the main group with a high statistical probability (p<0,01).
 Conclusions. The results of a clinical study showed the effectiveness of meloxicam (Alsokam) in the complex conservative treatment of patients with primary LBP in the period of exacerbation, which correlates with the effect of diclofenac sodium in the average daily dose. The nature and frequency of adverse reactions in the main and comparator groups showed that meloxicam in Alsocam has a significantly higher safety profile compared to diclofenac sodium, and its use in complex treatment regimens for patients with primary LBP syndrome reduces the risk of NSAIDs gastropathies.