medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-412medsovet-7933Research ArticleТЕРАПИЯ БОЛИPAIN THERAPYПерсонализированный подход к выбору анальгетика для лечения скелетно-мышечной болиPersonalized approach to choosing an analgesic for the treatment of musculoskeletal painhttps://orcid.org/0000-0002-1391-0711КаратеевА. Е.KarateevA. E.

Каратеев Андрей Евгеньевич – доктор медицинских наук, руководитель отдела воспалительных заболеваний суставов.

115522, Москва, Каширское шоссе, д. 34а

Andrey E. Karateev - Dr. Sci. (Med.), Head of the Department of Inflammatory Joint Diseases, Nasonova Research Institute of Rheumatology.

34а, Kashirskoe Shosse, Moscow, 115522

aekarat@yandex.ruНаучно-исследовательский институт ревматологии имени В.А. НасоновойРоссияNasonova Research Institute of RheumatologyRussian Federation202323112023021106114Copyright © Каратеев А.Е., 20232023Каратеев А.Е.Karateev A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7933

Хроническая скелетно-мышечная боль (СМБ), связанная с заболеваниями скелетно-мышечной системы, – одна из глобальных причин страданий, утраты трудоспособности, снижения качества жизни и ее продолжительности сотен миллионов жителей Земли. Поэтому эффективный контроль боли относится к числу первоочередных и наиболее важных задач лечения скелетно-мышечных заболеваний. С этой целью используется комплекс медикаментозных препаратов и нефармакологических подходов (кинезиотерапия, психологические методы, образовательные программы и др.). Принципиальную роль среди анальгетиков играют эффективные, доступные и удобные нестероидные противовоспалительные препараты (НПВП). Они относятся к препаратам «первой линии» для контроля СМБ. Однако при их назначении обязательно следует учитывать наличие коморбидной патологии как факторов риска лекарственных осложнений. При этом наиболее безопасным НПВП с точки зрения кардиоваскулярного риска является напроксен. Эффективность этого препарата доказана как при кратковременном лечении острой, так и при длительной терапии хронической боли. Напроксен превосходит по эффективности парацетамол и не уступает слабым опиоидам и другим НПВП, таким как ибупрофен и кеторолак. Данные клинических, наблюдательных и когортных исследований, а также их метаанализ подтверждают минимальный риск кардиоваскулярных осложнений при лечении напроксеном. Актуальной проблемой лечения СМБ является сочетание этой патологии с нарушениями сна, что определяет значительное ухудшение самочувствия и качества жизни пациентов. Применение комбинированного безрецептурного препарата напроксен и дифенгидрамина для кратковременной терапии инсомнии представляет новые возможности фармакотерапии в данной клинической ситуации.

Chronic musculoskeletal pain (CMSP) associated with diseases of the musculoskeletal system is one of the global causes of suffering, disability, and a decrease in the quality of life and its duration for hundreds of millions of people on Earth. Therefore, effective pain control is among the first and most important tasks of the treatment of musculoskeletal diseases. For this purpose, a complex of medications and non-pharmacological approaches (kinesiotherapy, psychological methods, educational programs, etc.) is used. Effective, affordable and convenient nonsteroidal anti-inflammatory drugs (NSAIDs) play a fundamental role among analgesics. They belong to the “first line” drugs for the control of SMB. However, when prescribing them, it is necessary to take into account the presence of comorbid pathology as risk factors for drug complications. At the same time, naproxen is the safest NSAID in terms of cardiovascular risk. The effectiveness of this drug has been proven both in the short-term treatment of acute and long-term therapy of chronic pain. Naproxen is more effective than paracetamol and is not inferior to weak opioids and other NSAIDs, such as ibuprofen and ketorolac. The data of clinical, observational and cohort studies, as well as their meta-analysis, confirm that the risk of cardiovascular complications in the treatment with naproxen is minimal. An urgent problem in the treatment of CMSP is the combination of this pathology with sleep disorders, which determines a significant deterioration in the well-being and quality of life of patients. The use of the combined over-the-counter drug naproxen and diphenhydramine for short-term therapy of insomnia presents new possibilities of pharmacotherapy in this clinical situation.

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The authors declare that there are no conflicts of interest present.