The individual characteristics of the patients with nonspecific back pain aff ecting the dynamics of pain syndrome in the treatment with non-steroidal anti-inflammatory drugs

Abstract

The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of patients with non-specific back pain is variable, from complete ineffectiveness to the occurrence of side effects. The eff ect of NSAIDs is affected by various factors, including individual characteristics of the patient. The aim of the study was to improve the diagnostic approach to patients with non-specific back pain to identify individual indicators that can affect the efficacy and safety of NSAID therapy. The study involved 139 patients — men and women aged 30 to 60 years — with acute nonspeci fic back pain. All patients took meloxicam or celecoxib for 10 days, then observed during 90 days. On the 1st, 10th, 30th and 90th days the patients were assessed on scales — Visual Analog Scale ( VAS), Beck Depression Inventory. In the 1st and 10th days in 20 patients we determined the levels of interleukin 1 (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10). The patients with arterial hypertension (p = 0,0053), diabetes (p = 0.04), depression (p = 0.01) had significantly worse treatment outcomes. Reduction in the levels of IL-1β and the ratio IL-6/IL-10 led to a significant reduction in pain intensity in patients with back pain. The prescription of NSAIDs for patients with back pain should be assessed from the perspective of the individual patient, including the presence of comorbidity, emotional or genetic markers, and so on, which should increase the efficiency and safety of NSAIDs treatment. Keywords: non-steroidal anti-inflammatory drugs, back pain, CYP2C9 genetic polymorphism, cytokines IL-1, IL-6/IL-10