Complex Pharmacotherapy Research Articles

Citalopram's impact on QTc circadian dynamics: mitigating risk of torsades de pointes and sudden cardiac death in complex pharmacotherapy scenarios

Citalopram's impact on QTc circadian dynamics: mitigating risk of torsades de pointes and sudden cardiac death in complex pharmacotherapy scenarios

Heart Failure with Improved Ejection Fraction: Insight into the Variable Nature of Left Ventricular Systolic Function.

The progress of contemporary cardiovascular therapy has led to improved survival in patients with myocardial disease. However, the development of heart failure (HF) represents a common clinical challenge, regardless of the underlying myocardial pathology, due to the severely impaired quality of life and increased mortality comparable with malignant neoplasms. Left ventricular ejection fraction (LVEF) is the main index of systolic function and a key predictor of mortality among HF patients, hence its improvement represents the main indicator of response to instituted therapy. The introduction of complex pharmacotherapy for HF, increased availability of cardiac-implantable electronic devices and advances in the management of secondary causes of HF, including arrhythmia-induced cardiomyopathy, have led to significant increase in the proportion of patients with prominent improvement or even normalization of LVEF, paving the way for the identification of a new subgroup of HF with an improved ejection fraction (HFimpEF). Accumulating data has indicated that these patients share far better long-term prognoses than patients with stable or worsening LVEF. Due to diverse HF aetiology, the prevalence of HFimpEF ranges from roughly 10 to 40%, while the search for reliable predictors and genetic associations corresponding with this clinical presentation is under way. As contemporary guidelines focus mainly on the management of HF patients with clearly defined LVEF, the present review aimed to characterize the definition, epidemiology, predictors, clinical significance and principles of therapy of patients with HFimpEF.

Chronic Cerebral Ischaemia Stages I-Ii of the Disease: Immune and Metabolic Disorders

Due to the increase in average-expectancy life in most developed countries and the environmental deterioration, there has been an increase in cerebrovascular and neurodegenerative diseases. Hence, this study attempts to analyze the chronic Cerebral Ischaemia Stages I-Ii of the disease, immune and metabolic disorders. To fulfil the study’s aim, seventy-five patients of the neurological department of “Kursk Regional Clinical Hospital” suffering from CCI in presence of hypertension, where 32 patients were with the stage I (1st main group) and 43 - with the stage II (2nd main group) at the age of 50 ± 5 years old are examined. In patients with chronic cerebral ischemia (CCI) stages I and II in presence of hypertension, among the 28 studied parameters of the immune and metabolic status of the blood plasma in addition to the content of the C4 component and the complement factor H inhibitor, 92,9% of the indicators were changed from the values of healthy donors at the start of treatment, in the patients with both stages of the disease 73,1% of these parameters turned out to be the same in magnitude and direction of changes, and 26,9% were identical in direction. The data obtained indicate the presence of immune inflammation, oxidative stress, endothelial dysfunction, and activation of lipid peroxidation in patients with CCI. The performed standard pharmacotherapy did not normalize 61,5% of the studied laboratory immune and metabolic indicators changed prior to the treatment in patients with CCI stage I and 76,9% of those with stage II, which, in its turn, makes necessary the correction of immunometabolic disorders at an early stage of the disease, studies of various combinations of preparations with antioxidant, nootropic, metabolic action in complex pharmacotherapy, and the introduction of immunomodulators into the accepted therapeutic regimens are necessary as well.

Nootropic properties of a new combined cytoprotective agent

Medicinal products of nootropic action, which have a positive effect on neurometabolism and normalize memory and intellectual functions, are an important component of complex pharmacotherapy for various neurological and cerebrovascular diseases. The aim of the work was an experimental study of the nootropic activity of the new combined drug Melarginin, which includes 3-(2,2,2-trimethylhydrazinium) propionate (meldonium), L-arginine, and inosine in a fixed ratio. In experiments on female Balb/c mice, it was established that Melarginin in doses of 250 and 500 mg/kg (per os for 14 days) statistically significantly increased the survival of animals in acute hypoxia, in a dose of 250 mg/kg - contributed to the preservation of cognitive function in experimental amnesia, improved spatial memory and recognition of the new location of the object, and in a dose of 500 mg/kg - increased muscle tone and endurance to physical and psychoemotional stress. The revealed effects indicate a nootropic effect due to the combined cyto- and cerebroprotective properties of the studied combined agent components. Based on the obtained data, the new pharmacological combination can be a promising drug for neurological recovery and improvement of physical and mental performance in chronic cerebrovascular pathology. Keywords: combined drug Melarginin, hypoxia, amnesia, nootropic activity.

The influence of the composition of the gel Soderm®-Forte and the metabolic energy corrector cytoflavin on the course of the inflammatory process in the conditions of experimental periodontitis

The study explored the possibility of combining the multitargent means of gel Soderm®-Forte and the metabolic energy corrector Cytoflavin in conditions of inflammatory pathology of periodontal tissues on a model of induced experimental periodontitis in rats. It is shown that the conduct of complex pharmacotherapy with drugs with antimicrobial, anti-inflammatory, energy-correcting and antioxidant orientation helps to reduce inflammatory phenomena in periodontal tissues, normalize osmotic exudation of the gingival fluid of the sulcular region and restore the index assessment of the tissues of the periodontal complex.
 The paper substantiates and shows the significance of the use of these drugs that can have a prolonged therapeutic effect on the peripheral microvascular network in the region of the gingival groove, reducing the exudative component in the postcapillary venules and arterioles by lowering perfusion pressure and reducing their permeability and improving protective effects under hypoxia.

Evaluation of the Pharmacotherapy Complexity Index in Patients of a Renal Transplant Clinic

Abstract:Objective: To evaluate the complexity of pharmacotherapy of kidney transplant patients in an outpatient clinic in the Brazilian Central-West region. Methods: This is a study that respects a descriptive cross-sectional design to evaluate the complexity index of pharmacological treatment through the documentary analysis of medical records. To calculate this index, the patient’s continuous use medications were considered, and the Pharmacotherapy Complexity Index (PCI) was adopted. To determine the PCI classification ranges, analysis of a larger group of patients (significant sample) was performed, and the quartiles of the PCI results were adopted. A pilot sample was used to describe the influence of drugs on PCI. Results: A total of 247 patients were included in the study to define the strata of treatment complexity. The PCI in the sample ranged from 10 to 83.5, and, by quartile analysis, up to 22.5 was considered low complexity, between 22.6 and 27.0 medium complexity, between 27.1 and 36.0 high complexity, and above 36.1 very high complexity. The case study for the PCI evaluation occurred with 20 patients and demonstrated that the complexity is not defined by the immunosuppressive treatment, but by the drugs used for the underlying diseases or the health problems arising from age and immunosuppression (comorbidities). Diabetes mellitus appears as the disease that contributes the most to complexity through the use of insulins. Conclusion: Patients with a higher number of drug doses and with conditions dependent on insulin therapy associated with immunosuppressive pharmacotherapy are the most complex and demand greater need for follow-up because of the difficulties faced in treatment.

Medication Regimen Complexity and Medication Burden Among Patients With Type 2 Diabetes Mellitus: A Retrospective Analysis.

Introduction: Most type 2 diabetes mellitus (T2DM) patients with chronic conditions require multiple medications to achieve and maintain good glycemic control. Objective: This study assessed medication burden, regimen complexity, and adherence among T2DM patients and evaluate its association with glycemic control. Method: We analyzed data of 2,696 T2DM patients at public health clinics in Malaysia from January 2018 until May 2019. Medication burden was based on medication count, regimen complexity was measured using the validated Medication Regimen Complexity Index (MRCI) tool, and adherence was measured using proportion of days covered (PDC) formula. Logistic regression models were used to compute unadjusted and adjusted odds ratio (aOR) with 95% confidence interval (CI) for association between the medication parameters and glycemic control (HbA1c ≤ 7.0%) over a 90-day period. Results: The cohort mean age was 60.4 years old (±10.8) and 62.9% were female. Overall, the average medication count was 4.8 with MRCI score of 15.1. Mean adherence score (PDC) was 90%. High medication count and MRCI scores were associated with lower odds of achieving good glycemic control (aOR 0.88; 95% CI 0.82, 0.94 and aOR 0.89; 95% CI 0.87, 0.92, respectively) while inverse association was observed between adherence and HbA1c level (aOR 2.7, 95% CI 1.66, 5.19). Similar findings were observed for diabetes-specific measures. Conclusions: High medication count, high regimen complexity, and low medication adherence were associated with poor glycemic control over the 3-month follow-up period. These parameters could be used to identify patients with complex pharmacotherapy regimens so that targets for intervention can be taken to achieve optimum outcomes and ease of self-care.

Glycemic control and associated factors in patients with type 1 diabetes mellitus in primary care in Southeastern Brazil

Diabetes is a self-managed condition with knowledge, attitudes and practices that can influence the overall treatment and outcomes delay the complications of diabetes. However, the few reported studies published point out that: low education level, poor adherence to pharmacotherapy and diet recommendations, infrequent monitoring of blood glucose, and insulin dosage regimen are associated with higher hemoglobin levels. This study aimed to assess the knowledge, adherence medication, and complexity of pharmacotherapy in T1DM patients in Brazil. A cross-sectional study was conducted involving 156 T1DM patients who were attending in primary care. Logistic regression analyses were conducted to assess the variables associated with glycemic control. The overall assessments of T1DM patients for the glycemic control were bad (121, 77.6%). However, T1DM patients with high MedTake Test (OR=2.4, CI=1.1-5.7) and Morisky-Green Test (OR= 2.5, CI=1.1-6.1), and in the use of dosage insulin (>40 units, OR=0.3, CI=0.1-0.7) and postprandial glucose (100-125mg/dl, OR=3.8, CI=1.1-14.6) had better glycemic control compared to uncontrolled patients. Glycemic control in Brazilians adults with T1DM is low. We suggested the screening patients with low MedTake and Morisky-Green Tests, increasing patient knowledge as part of a complex intervention that may lead to substantially improved treatment outcomes in primary care.

The interactions of abiraterone and its pharmacologically active metabolite D4A with cytochrome P450 2C9 (CYP2C9)

Interactions of cytochrome P450 2C9 (CYP2C9) were studied with the antitumor drug abiraterone and its pharmacologically active metabolite D4A, promising as an agent for prostate cancer treatment. It was shown by absorption spectroscopy, that both investigated compounds induced spectral changes of CYP2C9, indicating interactions of the pyridine nitrogen atom with the heme iron ion of the active site of the enzyme, but interactions of the ligands with the enzyme could be mediated by a water molecule bound to the heme iron ion. Based on the spectral changes, the values of dissociation constants (KS) for complexes of abiraterone and D4A with CYP2C9 were calculated as 1.73±0.14 μM and 3.95±0.16 μM. Both compounds inhibited O-demethylase activity of CYP2C9 towards its substrate. At 100 μM concentration of naproxen the concentrations of abiraterone, D4A and sulfaphenazole inhibiting CYP2C9 activity by 50% (IC50) were determined as 13.9 μM, 40 μM and 41 μM, respectively. The obtained results can be used for prognosis of drug-drug interactions at CYP2C9 level during administration of abiraterone or D4A as an antitumor agent for prostate cancer treatment in complex pharmacotherapy.

Basic supplementation of potassium and magnesium in the complex pharmacotherapy of patients with arterial hypertension and cardiac arrhythmias: results of a clinical and pharmacological study

Basic supplementation of potassium and magnesium in the complex pharmacotherapy of patients with arterial hypertension and cardiac arrhythmias: results of a clinical and pharmacological study

Complex pharmacotherapy of peptic ulcer disease taking into account its complications from other parts of the digestive system

The progressive view of domestic clinicians on peptic ulcer disease is well known not as a local process in the stomach or in the duodenum, but as a general disease of the body (M. M. Gubergrits, M. P. Konchalovsky, R. A. Luria, N. D. Strazhesko , M.V. Chernorutsky, etc.). However, despite the great work invested in the study of peptic ulcer disease, much in this problem remains unclear and not specified. In particular, the demands of healthcare practice and the results of existing methods of treating peptic ulcer disease do not meet.

Elusive Diagnosis of Superficial Peroneal Nerve Entrapment Case report

Isolated neuropathy of the superficial peroneal nerve (SPN) is a relatively rare type of peripheral neuropathy. It is linked to the mechanical entrapment of the SPN in predisposed locations of its anatomical pathway. Associated clinical findings are insufficient lifting of the latero-dorsal part of the foot, stepping on the lateral border of the foot, and commonly, a strong pain localized in the nerve dermatome.Case report. We describe a case of a 14-year-old female patient with right leg pain lasting 24 months. Repeated neurological examinations with negative findings on electromyography (EMG) were performed. The patient underwent a Steindler surgery for a suspected diagnosis of a heel spur, without any improvement. Despite complex pharmacotherapy, chronic pain developed. The patient was unable to walk, being bound to a wheelchair. Amputation of her lower limb under the knee was also considered. SPN entrapment was diagnosed at a physical examination at EuroPainClinics. Decompression of the SPN under local anaesthesia was performed at the clinic.Results. The symptoms improved immediately after the procedure, and following 2 months of rehabilitation, the patient was completely symptom-free. Her clinical state remains unchanged until this day.Conclusions. SPN entrapment is not a common diagnosis in the group of pain syndromes. Regarding the lower limb, it is imperative to include it on the list of differential diagnoses in cases of pain and functional disorders of the lateral muscle groups of the calf and leg. In the case of SPN entrapment, EMG findings may be negative.

Pilot of a pharmacist‐integrated interprofessional team to optimize prescribing in a telemedicine palliative care clinic

AbstractIntroductionThe rapidly growing number of frail elderly patients is leading to a greater need for palliative care services. Palliative care clinical pharmacy specialists (CPSs) can improve quality of care through comprehensive symptom and medication management. Incorporating pharmacists into palliative care through telemedicine meets complex pharmacotherapy needs of Veterans who have difficulty accessing care due to advanced illness.ObjectivesThe primary objective of this quality improvement project was to pilot a pharmacist‐integrated palliative care team clinic utilizing telemedicine to optimize palliative prescribing for Veterans and to describe CPS outcomes related to pharmacotherapy changes implemented. A secondary outcome was to assess Veteran satisfaction with assessments completed via telephone post visit.MethodsA CPS was integrated into the existing palliative care team beginning December 1, 2019 with video and audio telemedicine clinic appointments offered through May 31, 2020. The CPS completed comprehensive medication regimen reviews, assessed symptoms, and addressed medication‐related concerns during the visit. Recommendations for deprescribing opportunities and symptomatic management were provided to the consulting provider and/or primary treatment team. Recommendations made and those implemented within 30 days of the appointment were documented. Veteran satisfaction assessments were completed via telephone 14‐30 days after the clinic visit.ResultsThe palliative care team integrated a CPS and completed 25 consults via telemedicine technology between December 2019 and May 2020. The pharmacotherapy implementation rate was 60% (119/200) including a deprescribing rate of 57% (72/126), decreasing polypharmacy and potentially resulting in a decrease in adverse drug events. Veterans were on average very satisfied with their visit, with an assessment response rate of 56% (14/25).ConclusionPharmacist involvement with the palliative care team decreased polypharmacy, optimized symptom management, and increased use of telemedicine technology. Veterans were overall satisfied with the care received by the palliative care team via telemedicine technology.

A Systematic Review of Complex Polypharmacy in Bipolar Disorder: Prevalence, Clinical Features, Adherence, and Preliminary Recommendations for Practitioners.

Objective: Extensive combination pharmacotherapy regimens for bipolar disorder have gained increasing use in routine practice in ways that outpace data from evidence-based clinical trials. The present review examined the prevalence of complex pharmacotherapy regimens in bipolar disorder patients and sought to characterize factors that most influence polypharmacy prescribing patterns. Data Sources: The authors independently systematically searched the MEDLINE, PsycINFO, and Embase databases for English-language observational/naturalistic or randomized controlled polypharmacy trials, using the keywords bipolar and polypharmacy or bipolar and combination treatment and pharmacotherapy. Study Selection: From among 3,566 publications, 49 ultimately met study inclusion criteria. Data Extraction: Information was obtained regarding prevalence rates of extensive polypharmacy as well as clinical characteristics and naturalistic outcomes for patients with simple (≤ 2) or complex (≥ 3) regimens of psychotropic agents. Results: A weighted mean percentage of 32.7% of bipolar outpatients (4,535/13,863) taking ≥ 3 psychotropic medications was identified. Factors associated with complex polypharmacy use include female sex, White race, age > 50 years, history of psychosis, greater burden of depressive illness, subtherapeutic dosing, lower treatment adherence, more extensive psychiatric comorbidity, and a greater history of suicide attempts. Conclusions: Extensive or complex combination pharmacotherapy regimens are common in many patients with bipolar disorder and often reflect greater overall illness severity. Naturalistic studies do not point to better outcomes for patients receiving more complex drug regimens, suggesting likely confounding by indication, high severity, or comorbid conditions. Formal clinical trials are needed to identify optimal drug combinations and durations when using ≥ 3 psychotropic medications to treat patients with bipolar disorder.

Features of the immune status in patients with chronic and complicated pyodermas: choice of a therapeutic correction method


 
 Introduction: To compare the features of the immune status in patients with chronic and complicated pyoderma in the course of complex pharmacotherapy using immunomodulators based on transfer factors and glucosaminylmuramyldipeptide.
 Materials and methods: A clinical examination of 107 patients with pyoderma, divided into three groups, was carried out. All individuals underwent immunological examination before and after etiopathogenetic treatment. The patients of the first group were additionally treated with a drug containing signaling immunoactive molecules (transfer factor) as an immunomodulator; the patients of the second group received glucosaminylmuramyldipeptide; and the patients of the third group received standard antibacterial therapy.
 Results and discussion: Prior to the beginning of pathogenetic therapy, the patients were found to lack non-specific mechanisms of antimicrobial protection; there was a decrease in the activity and intensity of phagocytosis: phagocytic index and phagocytic number of neutrophils by 1.2 and 1.3 times; the production of proinflammatory cytokines IL-6 increased by 2.3 times, IL-8 –by 2.1 times, and TNFa – by 2.4 times. The study of immunological parameters after the inclusion of immunomodulators into the therapy revealed an increase in the phagocytic activity of neutrophils, and the indicators of the NST test were close to the control ones. The production of proinflammatory cytokines in the blood serum was restored to the level of the healthy individuals. Normalization of the number of CD4+-, CD8+-, CD19+-cells was observed in 86.0 ± 3% of the patients. At the same time, against the background of the use of glucosaminylmuramyldipeptide, a more intensive recovery of all links of anti-infectious immunity was recorded in comparison with the group where transfer factor molecules were used.
 Conclusion: A drug based on glucosaminylmuramyldipeptide can be recommended as the drug of choice in non-specific immunocorrection for complex pharmacotherapy of pyoderma accompanied by secondary immune insufficiency, in comparison with a drug containing transfer factors.
 
 

Moderate and deep procedural sedation-the role of proper monitoring and safe techniques in clinical practice.

Interventional pain management procedures provide significant improvement to patient quality of life and functionality. In-office procedures are becoming an increasingly more common site of pain management intervention for patients with minimal risk of harm. Moderate and deep sedation techniques can be used in patients with high anxiety, complex pharmacotherapy, or a low pain threshold. Proper guidance and oversight by an attending anesthesiologist, in addition to appropriate monitoring, are key. Epidural steroid injection complications rates have been cited at 2.4%, with the most common complications noted as persistent pain and flushing. Serious complication errors can be avoided with proper supervision and monitoring. The adherence to published societal recommendations and guidelines for indications of when to use moderate to deep sedation techniques, and appropriate supervision and monitoring methods, can avoid errors in interventional pain management procedures.

Potentially inappropriate prescriptions and therapeutic complexity in older HIV patients with comorbidities.

The prolonged current survival of human immunodeficiency virus (HIV) patients exposes them to new problems arising from the comorbidities they face. To describe the situation of comorbidities, polypharmacy, therapeutic complexity and adherence in people living with HIV over 65years of age and to assess the presence of potentially inappropriate prescriptions (PIP) by applying deprescription criteria. Observational study including HIV people (> 65years) from a university tertiary level hospital. Demographic, clinical and pharmacotherapeutic characteristics of the patients and their treatments were studied. The prevalence of polypharmacy (> 5 medications) and the pharmacotherapy complexity, quantified by the Medication Regimen Complexity Index (MRCI), were calculated. Therapeutic adherence was assessed by the Simplified Medication Adherence Questionnaire (SMAQ) and the medication possession ratio, according to prescription dispensing records. The Screening Tool of Older People's Prescriptions (STOPP) and List of Evidence-baSed depreScribing for CHRONic patients (LESS-CHRON) criteria were applied to identify PIP. PIP in elderly people living with HIV. Thirty patients were included, 73% of whom were men, with a median age of 71years (IQR 67 - 76) and a median duration of infection of 17years (IQR, 9 - 21). Seventy percent of the patients suffered from dyslipemia, 66.7% from hypertension, 43.3% from diabetes and 26.7% from mental health disorders. Seventy percent of the patients took more than 5 medications and 30% more than 10. The MRCI of concomitant medications was higher (18.3 points) than the MRCI of antiretroviral therapy (5.1 points), 66.7% of the studied population was classified as adherent. Finally, 70% of the patients present some PIP according to the STOPP or LESS-CHRON criteria. The polypharmacy was significantly associated (p = 0.008) with meeting deprescription criteria. The elderly people living with HIV present numerous comorbidities and met the criteria for polypharmacy. Their pharmacotherapy complexity is mainly determined by the concomitant treatments. There is a high prevalence of meeting deprescription criteria in people living with HIV over the age of 65 and a clear relationship between polypharmacy and deprescription. The optimization of pharmacotherapy is necessary in this population.

Pharmacological/pharmaceutical counseling in intensive care medicine

Adequate pharmacotherapy in critically ill patients is challenging for many clinicians. Disease-related pathophysiological changes often lead to complex therapy strategies including many intensive care treatments (e.g. invasive ventilation, renal replacement therapy). These measures often influence drug prescribing and dosing. Therefore, in organ dysfunction such as renal and liver impairment reduced drug elimination has to be considered by adapting drug dosing towards elimination rates. Moreover, as intensive care medicine often includes the use of multiple drugs the risk for drug-drug interactions increases. The current article gives an overview about the complexity of individual pharmacotherapy in intensive care units whilst providing information for its clinical implementation.

Highlights of Pharmacist Roles in Hematopoietic Cell Transplantation and Cellular Therapy.

Patients with hematological malignancies receiving hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor (CAR) T-cell therapy are known to have complex pharmacotherapy. To ensure safe and effective care in preventing and managing drug-related problems, pharmacists trained in HSCT and CAR T-cell therapy fulfill various roles in providing care for these patients. With polypharmacy and complex medication regimens, drug interactions are one of the major aspects that pharmacists review regularly to ensure the efficacy of treatment while minimizing toxicity. Pharmacists anticipate various complex drug interactions, understanding the possible mechanisms of drug interactions, and manage these complex drug regimens in patients undergoing HSCT and CAR T-cell therapy. In addition, antimicrobial prophylaxis is also important supportive care for immunocompromised patients. Pharmacists are capable of evaluating the risk of opportunistic infections, anticipating the type of antimicrobial prophylaxis required, and setting a policy with a robust antimicrobial regime. This can promote consistency in patient care and improve patient outcomes in terms of morbidity and mortality associated with opportunistic infections. Lastly, pharmacists are equipped with a skillset to ensure a seamless transition of care, provide education for patients and healthcare providers, promote medication adherence, and contribute to research and quality improvement.

Возможности терапии болевого синдрома у больных сахарным диабетом

The prevalence of lower back pain (LBP) in type 2 diabetes mellitus (DM2) is almost 2 times higher than in the similar control group (by age and gender). The association of DM2 with the severity, chronicity and recurrence of LBP was revealed. DM2 duration correlates with the severity and prevalence of degenerative-dystrophic changes. The representation of concomitant somatic pathology in patients with DM2 is significantly higher than in patients without DM2. Rational selection of the therapy regimen for LBP should be based on comorbid pathology. The molecular mechanisms of synergism of muscle relaxant (tolperizone), nonsteroidal anti-inflammatory drug (NSAID) (meloxicam), and B vitamins as part of complex pharmacotherapy of pain were analyzed. This treatment regimen has a number of benefits: lack of dependence, anti-inflammatory effect, neuroprotective and remyelinating effect, reduction of muscular hypertonus. A number of studies have shown the efficacy of such combination therapy in patients of different age groups with comorbid conditions. It does not require an increase in NSAID doses and significantly reduces the risk of adverse events (AE). The applied treatment regimen is a combination of a muscle relaxant (tolperizone), NSAID (meloxicam) and a complex of B vitamins has already demonstrated its efficacy in the treatment of LBP in patients with comorbid diseases, according to the effect on the inflammatory process indicators (in the absence of AE). KEYWORDS: diabetes mellitus, lower back pain, body mass index, nonsteroidal anti-inflammatory drugs, meloxicam, muscle relaxants, tolperizone, B vitamins. FOR CITATION: Shavlovskaya O.A., Bokova I.A., Shavlovsky N.I., Yukhnovskaya Yu.D. Possibilities of pain syndrome therapy in patients with diabetes mellitus. Russian Medical Inquiry. 2021;5(5):307–315 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-307-315.