TREATMENT FOR ACUTE/SUBACUTE MUSCULOSKELETAL PAIN, BY USING AN ALGORITHM FOR STEPWISE CHOICE OF ANALGESIC DRUGS AND FOR MONITORING THEIR EFFICACY: PRELIMINARY DATA OF THE ANALGESIC TREATMENT USING SYSTEMIC ALGORITHM (ATUSA) PROGRAM

Abstract

To optimize treatment for musculoskeletal pain (MSP) is a topical medical and social problem. A meeting of experts was held inMoscowin June 2015 to discuss the possibility of forming an interdisciplinary approach and elaborating a unified MSP treatment algorithm based on the com prehensive pathogenetically justified use of different classes of medicines. The Analgesic Treatment Using a Systemic Algorithm (ATUSA) trial is a retrospective observational study of the effectiveness of this approach in clinical practice. Objective: to investigate the efficiency of combination treatment for MSP in real clinical practice. Patients and methods. A study group consisted of 3304 patients (women (54.3%) and men (45.7%); mean age 48.9±14.6 years) with osteoarthritis, nonspecific back pain, and rheumatic juxta-articular soft tissue pathology who had visited their doctors for acute/subacute MSP. Treatment was performed in accordance with the following algorithm: the first appointment was a nonsteroidal anti-inflammatory drug (NSAID), such as aceclofenac), in case of contraindications, paracetamol and/or tramadol + a topical NSAID, in case of indications, muscle relaxants. The therapeutic efficiency was monitored every 7 days (a total of 4 visits); during each visit, therapy could be changed: switching to another NSAID, local administration of glucocorticoids (GC), as well as antidepressants or anticonvulsants. The dynamics of pain (a 0–10 pain intensity numeric rating scale), the number of patients in whom MSP had been resolved completely, as well as treatment satisfaction were taken into account to assess the results of treatment. Results. The first appointment in 97.5% of the patients was NSAIDs, mainly aceclofenac (93.7%), that was used in combination with a muscle relaxant in 67.7%. By Visit 4, there was a reduction in MSP from 6.9±1.5–2.2±1.3 scores. MSP was completely resolved in 77.0% of the patients. The vast majority (88.4%) of the patients rated their treatment outcome as good or excellent. There was a need for switching to another NSAID in 8.1% of cases, local administration of GC in 1.9%; use of an antidepressant or an anticonvulsant in 1.5%, and hospitalization in 0.25%. Adverse reactions were noted in 2.2% of the patients. Conclusion. The application of the treatment algorithm based on a pathogenetic approach ensures effective and relatively safe relief of MSP in most patients.