Treatment Of Acute Back Pain Research Articles

Місце центральних міорелаксантів у лікуванні неспецифічного болю в спині

У роботі розглянуто сучасні стратегії фармакологічного лікування неспецифічного болю в спині. Показано, що, незважаючи на деякі контраверсійні підходи до лікування згідно з останніми клінічними рекомендаціями, центральні міорелаксанти продовжують займати значне місце у лікуванні болю в спині. У той же самий час ненаркотичні анальгетики (парацетамол) вже не вважаються препаратами першої лінії терапії гострого болю в спині, як це було рекомендовано ще декілька років тому назад. Проведено аналіз групи міорелаксантів центральної дії. Показані значна неоднорідність групи та індивідуальні розбіжності різних препаратів. Щодо деяких препаратів групи їх виробники отримали приписи від регуляторних органів внаслідок несприятливого співвідношення «користь — ризик». Більш детально розглянутий один з препаратів групи центральних міорелаксантів — циклобензаприн, що є новим на фармацевтичному ринку України. Наголошується, що однією з вагомих переваг є лікарська форма цього препарату з повільним вивільненням діючої речовини. Це дозволяє використовувати циклобензаприн один раз на добу та сприяє покращанню профілю безпеки препарату та комплайєнтності пацієнтів.

Acute back pain: Diagnostic and therapeutic algorithms

The problem of diagnosis and treatment of acute back pain is discussed. Information concerning the etiology, pathogenesis, classification, clinic, diagnostic methods and principles of treatment of this pathology is presented. Special attention is paid to non-selective non-steroidal antiinflammatory drugs acting on both types of cyclooxygenase, which are the drug of choice for the treatment of vertebrogenic pain syndromes.

Efficacy of tolperisone versus meloxicam in the treatment of nonspecific acute neck pain

Neck pain is a widespread disease that significantly impairs quality of life in patients. General approaches to managing patients with acute neck pain are generally consistent with the recommendations for the treatment of acute back pain: its pharmacotherapy includes nonsteroidal antiinflammatory drugs (NSAIDs) and muscle relaxants. Objective of the observational program: to compare the efficiency of treatment for nonspecific acute neck pain with tolperisone 150 mg/day, followed by dose escalation up to 450 mg/day, versus meloxicam 15 mg/day for 14 days. Patients and methods. The observational program covered 37 patients aged 18–65 years who were diagnosed with acute nonspecific neck pain; of them 19 patients made up Group 1 and 18 formed Group 2. Group 1 was prescribed tolperisone (Calmirex) as tablets: 150 mg/day on day 1, 300 mg/day on day 2, and 450 mg/day on day 3 until the end of therapy. On day 1 of the investigation, Group 2 received meloxicam 15 mg/day in two divided doses (7.5 mg in the morning and evening). At baseline and on days 7 and 14 days of therapy, the investigators assessed the dynamics of pain using a visual analogue scale (VAS), as well as its intensity at rest and during movement; neck disability index (NDI) and recorded adverse events. Results and discussion . The two groups showed a significant decrease in pain intensity on both 7 and 14 days of therapy. The rate of effect onset was significantly faster in the meloxicam group. On day 14 of treatment, both patient groups showed a considerably better functional state in terms of activity limitations due to neck pain (NDI); patients' perceptions of therapy were rated as good and excellent in most cases. On 14 days of therapy, the degree of pain reduction in the meloxicam group was higher, but the differences with that in the tolperisone group did not reach statistical significance, which can indicate the comparable efficacy of the drugs. Conclusion. The data of this observational program are consistent with the recommendations for the treatment of nonspecific acute neck pain, which indicate NSAIDs and muscle relaxants as drugs for the treatment of this disease.

Alternative analgesics: the possibility of B vitamins

Several studies have shown antinociceptive effects and antigiperalgezichesky using thiamine, pyridoxine and cyanocobalamin on hyperalgesia models suggested that the combination of the result of the activation of thiamine, cyanocobalamin, pyridoxine increase the synthesis and secretion of serotonin in various parts of the brain. Furthermore, the analgesic effect of vitamin B, associated with increased inhibitory control of afferent nociceptive neurons in the spinal cord and the decrease in thalamic neurons of nociceptive stimulation response. The results of the analysis of the effectiveness of the drug Vitakson having analgesic effect. The study confirms the clinical experience with the high efficiency of B vitamins in the treatment of acute back pain (lumbago). Monotherapy Vitakson accompanied by significantly greater (p <0.05) reduction in the intensity of pain in lumbago throughout the course of treatment (10 days) in the substantial absence of undesirable side effects.

ANTIDEPRESSANTS` EFFECTS ON TREATMENT RESULTS OF ACUTE BACK PAIN

We presented the results of clinical trial of the effectiveness of antidepressants in acute and chronic back pain. It is shown that in patients with anxiety, depressive symptoms and emotional factors as triggers of disease exacerbation, inclusion of antidepressants in the complex treatment of acute back pain greatly increases the efficiency and reduces the time of treatment

Response of community pharmacists to the presentation of back pain: a simulated patient study

Abstract Objective To assess the response of community pharmacists to the presentation of back pain. Method The researcher posed as a customer to obtain medication for back pain for her grandfather, and the consultations were recorded in a pretested data collection form. Setting The study was conducted in 100 randomly selected community pharmacies located within the Klang Valley in Malaysia. This includes Kuala Lumpur, the capital city of Malaysia and its surrounding suburban areas. Key findings In 85% of the consultations, pharmacists asked at least one question before recommending a treatment. The patient's medical history was the most frequently asked question by the pharmacists (60%). In general, a median of only five counselling elements were addressed by the pharmacists out of 13 recommended. The most common element of counselling addressed was the route of administration (98%), followed by the frequency and dose to be taken (92% and 88%, respectively). None of the pharmacists asked the ‘customer’ whether she required any further information. The number of counselling elements addressed was significantly associated with the age of the pharmacist, duration of consultation and the types of medication recommended (P < 0.05). Most of the pharmacists (88%) recommended at least an oral non-steroidal anti-inflammatory drug or a selective cyclooxygenase-2 inhibitor for the treatment of acute back pain. Diclofenac was the most commonly recommended medication for back pain (55% of consultations), followed by meloxicam (15%). The cost of treatment for back pain ranged from RM2.00 to RM38.00 with a median of RM10.00. Conclusion This study demonstrates that the extent of information gathering and counselling varied among community pharmacists in Malaysia and that in general, this appeared to be suboptimal. Professional bodies such as the Malaysian Pharmaceutical Society should create awareness among pharmacists regarding their responsibility to counsel patients or their caregivers.

McKenzie treatment for acute back pain added to first-line care does not result in appreciable clinical improvements

McKenzie treatment for acute back pain added to first-line care does not result in appreciable clinical improvements

O-demethylation of codeine to morphine inhibited by low-dose levomepromazine

Codeine/paracetamol (C/P) and levomepromazine (L) are frequently co-administered for the treatment of acute back pain, but the efficacy/effectiveness of this combination drug therapy has not been evaluated. The demethylation of codeine to morphine is catalyzed by the polymorphic enzyme cytochrome P450 2D6 (CYP2D6), of which levomepromazine (methotrimeprazine) is a known inhibitor. The aim of this study was to investigate whether low-dose levomepromazine inhibits the formation of morphine from codeine in a patient population of homozygous extensive (EM) and heterozygous extensive (HEM) metabolizers of CYP2D6. Our patient cohort consisted of 29 patients hospitalized for acute back pain who were randomized to a 24-h treatment with either C/P (60 mg codeine + 1000 mg paracetamol) four times daily or to L+C/P (levomepromazine 5 + 5 + 5 + 10 mg + C/P) four times daily. After zero-urine sampling (baseline), the treatment was started and urine collected for 24 h. Blood samples were later genotyped for the CYP2D6*3, *4, and *6 polymorphisms by the PCR (LightCycler system) and for the *5 polymorphism using long PCR, to identify EM and HEM and to eliminate CYP2D6 poor metabolizers. Urine samples were analyzed using the CEDIA immunoassay and gas chromatography-mass spectrometry after enzymatic hydrolysis of glucuronide conjugates. O-demethylation ratios of codeine were calculated as hydrolyzed (total) concentrations of morphine/morphine + codeine. Twenty-two of the patients fulfilled the inclusion criteria, of whom ten were EM (five C/P and five L+C/P) and twelve were HEM (six C/P and six L+C/P) for functional CYP2D6 alleles. In the EM group, the median O-demethylation ratio was significantly higher (P = 0.016, Mann-Whitney test) after the C/P treatment (0.092, range 0.041-0.096) than after the L+C/P treatment (0.031, range 0.009-0.042). However, there was no significant difference between these two treatments in either the HEM group [n = 12; 0.024 (range 0.011-0.042) vs. 0.026 (range 0.009-0.041), respectively; P = 1.00] or in the combined EM/HEM group [11 C/P + 11 L+C/P; 0.041 (range 0.011-0.096) vs. 0.030 (range 0.009-0.042), respectively; P = 0.122]. Our study revealed significant inhibition in the O-demethylation of codeine to morphine in homozygous EM of CYP2D6 treated with low-dose levomepromazine and codeine/paracetamol, compared to treatment with codeine/paracetamol only. No significant difference could be detected in HEM or in the mixed and heterogenous group of EM/HEM. In patients prescribed this drug combination, the amount of morphine generated by the O-demethylation of codeine may be insufficient for effective pain relief. The therapeutic effect of codeine in the treatment of acute back pain should be assessed with and without levomepromazine.

Évaluation de la prise de décision de prescription d’un antalgique en prise quotidienne unique ou multiple dans les rachialgies aiguës

Decisions about treatment prescriptions depend on many factors. For example, the choice of once-daily or multiple administration of an analgesic, an aspect that is not determined by guidelines, depends essentially on medical practice habits, patient preferences, or both. We analyzed this treatment decision for acute back pain in a case-control study. A case-control study was conducted in metropolitan France between October and December 2005 among outpatients seeing general practitioners and specialists for acute back pain (cervical, thoracic, lumbar and low back pain). We compared the group treated by a once-daily analgesic (tramadol) with those treated by analgesics (WHO analgesic ladder steps 1 and 2) administered twice daily or more. Patients and physicians were questioned about the different supposed determinants of the treatment choice for acute back pain. Patients for whom physicians prescribed a once-daily analgesic had a history of back pain and previous prescriptions for other analgesics more frequently than the other patients, experienced significantly greater pain and more marked disability. The time to recovery estimated by the physicians was shorter for these patients, as was the time to return to work, estimated by patients. Treatment choice was also guided by the patient's choices: the once-daily analgesic was reserved for patients who prefer to take drugs to prevent pain and prefer a single dose daily. The choice of type of analgesic treatment for acute back pain depends not only on clinical condition (pain and disability), but also on clinical history, the future as envisioned by the physician and the patient's desires. Action to improve treatment choices must integrate these factors, especially as part of an overall education in therapeutics.

Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations

Background context Acute back pain and sciatica are major sources of disability. Many medical interventions are available, including manipulations, with conflicting results. Purpose To assess the short- and long-term effects of spinal manipulations on acute back pain and sciatica with disc protrusion. Study design/setting Randomized double-blind trial comparing active and simulated manipulations in rehabilitation medical centers in Rome and suburbs. Patient sample 102 ambulatory patients with at least moderate pain on a visual analog scale for local pain (VAS1) and/or radiating pain (VAS2). Outcome measures Pain-free patients at end of treatment; treatment failure (proportion of patients stopping the assigned treatment for lack of effect on pain); number of days with no, mild, moderate, or severe pain; quality of life; number of days on nonsteroidal anti-inflammatory drugs; number of drug prescriptions; VAS1 and VAS2 scores; quality of life and psychosocial findings; and reduction of disc protrusion on magnetic resonance imaging. Methods Manipulations or simulated manipulations were done 5 days per week by experienced chiropractors, with a number of sessions which depended on pain relief or up to a maximum of 20, using a rapid thrust technique. Patients were assessed at admission and at 15, 30, 45, 90, and 180 days. At each visit, all indicators of pain relief were used. Results A total of 64 men and 38 women aged 19–63 years were randomized to manipulations (53) or simulated manipulations (49). Manipulations appeared more effective on the basis of the percentage of pain-free cases (local pain 28 vs. 6%; p<.005; radiating pain 55 vs. 20%; p<.0001), number of days with pain (23.6 vs. 27.4; p<.005), and number of days with moderate or severe pain (13.9 vs. 17.9; p<.05). Patients receiving manipulations had lower mean VAS1 (p<.0001) and VAS2 scores (p<.001). A significant interaction was found between therapeutic arm and time. There were no significant differences in quality of life and psychosocial scores. There were only two treatment failures (manipulation 1; simulated manipulation 1) and no adverse events. Conclusions Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.

Treatment of low back pain: monitoring clinical practice through audit

Objectives Back pain is one of the most common causes of disability in the UK. Management guidelines for the treatment of acute back pain have been published. Auditing patients’ physiotherapy treatment records is one way of monitoring standards of care. Standards were developed using published evidence-based treatment, self-management guidelines and local standards within a physiotherapy outpatient department. Design Physiotherapy treatment notes for patients referred with low back pain were audited in 1996 (Audit 1). The audit was repeated in 2001 (Audit 2) after additional standards were implemented following the results of Audit 1. Setting Physiotherapy Outpatient Department, Addenbrooke's NHS Trust Hospital, Cambridge, UK. Results In Audit 1, 66% and 88% of patient records indicated that they were compliant with the standards for acute and chronic back pain, respectively. Sixty-four percent of patients were advised to keep active, 96% showed evidence of diagnostic triage, 65% showed evidence of mobilisation, none were recommended bed rest (100% compliance), and there was no evidence of manipulation. In Audit 2, 57% and 51% of patient records indicated that they were compliant with the standards for acute and chronic back pain, respectively. Thirty percent were considered to be yellow flags, 59% showed evidence of mobilisation, 100% showed evidence of diagnostic triage and did not recommend bed rest, 60% were referred for rehabilitation, and there was no evidence of manipulation. Changes instigated included new appointment and referral systems and new topics for staff education. Conclusion Auditing physiotherapy treatment notes of patients with low back pain has been shown to be useful in monitoring areas of good practice and in identifying practice in need of development. Clinical audit should be seen as a quality improvement process that aims to optimise patient care.

European Comparison of Costs and Quality in the Treatment of Acute Back Pain

Retrospective multicenter observational study. To compare the outpatient quality and costs of treating acute back pain in England, Germany, the Netherlands, and Switzerland. No study has yet attempted to compare the quality, costs, and resource utilization of acute back pain treatment in Europe. A total of 130 randomly selected physician practices assessed services for 1 hypothetical average patient during the first 4 weeks of treatment (cost evaluation) and 127 practices reported retrospective data on 1 real patient (quality evaluation) in 2001. Reimbursement fees served as unit costs for Germany and Switzerland. Average reimbursement fees were used to measure resource utilization in all countries. Quality of care was assessed in terms of the following unnecessary treatments and diagnoses: bed rest for more than 2 days; exercise therapy; scheduling of a radiograph or other imaging tests; and referral to another provider. Responses were weighted with the level of scientific evidence for overuse. Weighted-average overuse ranged from 18% in the Netherlands to 31% in Germany. In England, Germany, and Switzerland, at least a third of the resources used to treat back pain were wasted. There was considerable waste in treating acute back pain. The Netherlands had highest quality and lowest resource utilization in providing treatment for acute back pain.

First case of multiple discitis and sacroiliitis due to Abiotrophia defectiva

The case reported here is, to the best of our knowledge, the first of probable endocarditis revealed by sacroiliitis and multiple discitis due to Abiotrophia defectiva. This organism was formerly included with Granulicatella in the group of “satellite” streptococci because of its growth pattern as satellite colonies in the vicinity of unrelated bacteria and in the group of “nutritionally variant streptococci” (NVS) because of its fastidious growth in vitro [1, 2]. It is a member of the normal flora of the human oropharyngeal, urogenital and intestinal tracts and an infrequent cause of endocarditis [3, 4]. To our knowledge, only five cases of osteoarticular infections due to NVS have been reported to date, including one case of culture-negative arthritis (with endocarditis) [1], one case of osteomyelitis (secondary to a pacemaker infection) [5] and two cases of vertebral osteomyelitis and discitis (secondary to endocarditis) [6], all due to G. adiacens, and only one knee arthroplasty infection due to A. defectiva [7]. A 51-year-old male was admitted to our hospital for treatment of acute back pain without fever associated with sciatica. He had suffered from stable grade III mitral valvulopathy for 10 years. During the 6 weeks before admission he

Pelvic Traction as Treatment for Acute Back Pain

Pelvic Traction as Treatment for Acute Back Pain

Pelvic traction as treatment for acute back pain: Efficacious, benign or deleterious?

Pelvic traction as treatment for acute back pain: Efficacious, benign or deleterious?