New therapeutic options for musculoskeletal pain
https://doi.org/10.21518/2079-701X-2019-6-34-40
Abstract
Musculoskeletal pain (MSP) is one of the major interdisciplinary problems of modern medicine and society. Inflammation is a universal mechanism that plays a crucial role in the development of acute and chronic MSP. Therefore, non-steroidal antiinflammatory drugs (NSAIDs) are the first-line treatment for MSP. The effectiveness of all NSAIDs in reducing pain and inflammation is approximately the same, and the degree of safety is determined by their relationship to COX-1 and COX-2 enzymes. Thanks to pharmacological properties and a balanced profile of efficiency and safety, the successful position of the «golden mean» between cokebins and non-selective NSAIDs is a moderately selective aceklofenac, which makes it appropriate for the vast majority of patients with MSP. Introduction into clinical practice of the drug Aceklagin containing 200 mg of aceсlofenaс in a new drug form with modified two-phase release, opens up new possibilities of MSP therapy. Due to the stable concentration of aceclofenac in the body during the day, Aceklagin improves the efficiency of pain and inflammation treatment in patients with MSP, while maintaining a high level of safety inherent in this molecule.
About the Authors
A. В. Danilov
Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health of the Russian Federation (Sechenov University)
Russian Federation
Russian Federation
Alexei Borisovich Danilov – Dr. of Sci. (Med), Professor of the Department of Nervous Diseases of the Institute of Postgraduate Education of the Federal State Autonomous Educational Institution of Higher Education «First Moscow State Medical University named after I.M. Sechenov» of the Ministry of Health of the Russian Federation (Sechenov University), Director of the Institute of Interdisciplinary Medicine
119991, Moscow, B. Pirogovskaya St., 6, Bldg. 1
V. В. Korzhavina
Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after I.M. Sechenov of the Ministry of Health of the Russian Federation (Sechenov University)
Russian Federation
Russian Federation
Victoria Borisovna Korzhavina – Candidate of Medical Sciences, Assistant to the Department of Nervous Diseases of the Institute of Postgraduate Education
119991, Moscow, B. Pirogovskaya St., 6, Bldg. 1
References
1. Yakhno N.N., Kukushkin M.L. Pain (practical guide for doctors). Moscow: Russian Academy of Medical Sciences Publishing House; 2012. 512 c. (In Russ.)
2. Zhu K., Devine A., Dick I. et al. Association of back pain frequency with mortality, coronary heart events, mobility, and quality of life in elderly women. Spine. 2007;32(18):2012–8.
3. Nasonov E.L., Yakhno N.N., Karateev A.E., Alekseeva L.I., Barinov A.N., Barulin A.E., et al. General principles of treatment of musculoskeletal pain: an interdisciplinary consensus. Scientific and practical rheumatology. [Nauchno-prakticheskaja revmatologija]. 2016;54(3):247-265. (In Russ.)
4. Karateev A.E. Control of musculoskeletal pain: is it possible to create a common algorithm of therapy? Clin. pharmacol. ther. [Klin. farmakol. ter.], 2016;25(2):43-53. (In Russ.)
5. Clauw D.J. Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s). Best Pract Res Clin Rheumatol. 2015;29(1):6-19.
6. de Queiroz B.Z., Pereira D.S., Lopes R.A., et al. Association between the plasma levels of mediators of inflammation with pain and disability in the elderly with acute low back pain: data from the Back Complaints in the Elders (BACE)-Brazil Study. Spine (Phila Pa 1976). 2016;41(3):197-203.
7. Weber K.T., Satoh S., Alipui D.O. et al. Exploratory study for identifying systemic biomarkers that correlate with pain response in patients with intervertebral disc disorders. Immunol Res. 2015;63(1-3):170-80.
8. McCarberg B.H., Ruoff G.E., Tenzer-Iglesias P., Weil A.J. Diagnosis and treatment of low-back pain because of paraspinous muscle spasm: a physician roundtable. Pain Med. 2011;12(Suppl 4):S119-27.
9. Lund J.P., Donga R., Widmer C.G., Stohler C.S. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol. 1991;69:683–94.
10. Roland M. A critical review of the evidence for pain-spasm-pain cycle in spinal disorders. Clin Biomech. 1986;1:102–9.
11. Karateev A.E., Nasonov E.L., Yakhno N.N., Ivashkin V.T., Chichasova N.V., Alexeeva L.I., et al. Clinical recommendations «Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice». Modern rheumatology [Sovremennaja revmatologija.] 2015;1:4-24. (In Russ.)
12. Karateev A.E., Alekseeva L.I., Tsurgan A.V., Gontarenko N.V. Therapy of acute/subacute skeletal-muscular pain: results of the ALISA observation study (Analgetic Treatment with the Use of Systemic Algorithm). Therapeutic archive [Terapevticheskij arhiv]. 2017;12(Issue 2): 175-184. (In Russ.)
13. Karateev A.E., Misyuk A.S. Non-steroidal anti-inflammatory drugs as the first step in the treatment of musculoskeletal pain. Modern rheumatology [Sovremennaja revmatologija]. 2015;9(3):61–69. (In Russ.)
14. Karateev A.E., Uspensky Y.P., Pakhomova I.G., Nasonov E.L. Short course of history of NSAIDs. Scientific and practical rheumatology. [Nauchno-prakticheskaja revmatologija.] 2012;52(3):101-116. (In Russ.)
15. Pasero G., Marson P. A short history of anti-rheumatic therapy. II. Aspirin. Reumatismo. 2010;62(2):148–56.
16. Schrör K. 100 years of successful drug discovery. The history of aspirin. Pharm Unserer Zeit. 2009;38(4):306–13.
17. Vane J. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nat New Biol. 1971;231(25):232–5.
18. Vane J., Botting R. New insights into the mode of action of anti-inflammatory drugs. Inflamm Res. 1995;44(1):1–10.
19. Danilov A.B., Danilov Al.B. Pain management. Biopsychosocial approach. MOSCOW: «AMM-PRESS», 2016. 636 p. (In Russ.)
20. Hinz B., Rau T., Auge D. et al. Aceclofenac spares cyclooxygenase 1 as a result of limited but sustained biotransformation to diclofenac. Clin Pharmacol Ther. 2003;74:222–35.
21. Dooley M., Spencer C.M., Dunn C.J. Aceclofenac:a reappraisal of its use in the management of pain and rheumatic disease. Drugs. 2001;61(9):1351-1378.
22. Schattenkirchner M., Milachowski K.A. A doubleblind, multicentre, randomised clinical trial comparing the efficacy and tolerability of aceclofenac with diclofenac resinate in patients with acute low back pain. Clin Rheumatol. 2003 May;22(2):127–35.
23. Lemmel E.M., Leeb B., De Bast J., Aslanidis S. Patient and physician satisfaction with aceclofenac: results of the European Observational Cohort Study (experience with aceclofenac for inflammatory pain in daily practice). Aceclofenac is the treatment of choice for patients and physicians in the management of inflammatory pain. Curr Med Res Opin. 2002;18(3):146–53.
24. Yanagawa A., Kudo T., Shimada J., et al. Endoscopic evaluation of Aceclofenacinduced gastroduodenal mucosal damage: a double-blind comparisonr with sodium Diclofenac and Placebo. Jap J Rheumatol. 1998;8:249–59.
25. Grau M., Guasch J., Montero J.L., et al. Pharmacology of the potent new nonsteroidal anti-inflammatory agent aceclofenac. Arzneimittelforschung. 1991 Dec;41(12):1265–76.
26. Helin-Salmivaara A., Virtanen A., Vesalainen R., et al. NSAID use and the risk of hospitali-zation for first myocardial infarction in the general population: a nationwide case-control study from Finland. Eur Heart J. 2006 Jul;27(14):1657–63. Epub 2006 May 26.
27. Leela A.M. Application of Aertal (aceclofenac) in clinical practice. RMJ. 2009;(4):291–5. (In Russ.)
28. Nasonova V.A., Karateev A.E. Symptomatic therapy of pain in rheumatic diseases: the place of aceklofenak. Modern rheumatology [Sovremennaja revmatologija.] 2009;3(3):58–65. (In Russ.)
29. Zamyatina E.A., Bagirova G.G. Application of meloxycam (movalis) and aceсlofenac (aertal) in elderly people with osteoarthritis. News from higher education institutions. Volga region. Medical sciences. [Izvestija vysshih uchebnyh zavedenij. Privolzhskij region. Medicinskie nauki.] 2012;21(1):40–6. (In Russ.)
30. Pchelintsev M.V. Aceclofenac – a new form, new possibilities of application. Manage Pain. 2018;4:8-16. (In Russ.)
31. Soo Kyung Bae, Soo-Hwan Kim, Hae Won Lee, Sook Jin Seong, Su-Yeon Shin, Sang Hun Lee, Mi-Sun Lim, Young-Ran Yoon and Hye Jung Lee. Pharmacokinetics of a New Once-Daily Controlled-Release Formulation of Aceclofenac in Korean Healthy Subjects Compared with Immediate-Release Aceclofenac and the Effect of Food A Randomized, Open-Label, Three-Period, Crossover, Single-Centre Study. Clin Drug Investig. 2012;32(2):111–119.
32. Jae-Ho Yang, Kyung-Soo Suk, Byung-Ho Lee, WooChul Jung, Young-Mi Kang, Ji-Hye Kim, HakSun Kim, Hwan-Mo Lee, Seong-Hwan Moon. Efficacy and Safety of Different Aceclofenac Treatments for Chronic Lower Back Pain: Prospective, Randomized, Single Center, Open-Label Clinical Trials. Yonsei Med J. 2017 May;58(3):637–643
Review
For citations:
Danilov AВ, Korzhavina VВ. New therapeutic options for musculoskeletal pain. Meditsinskiy sovet = Medical Council. 2019;(6):34-40. (In Russ.) https://doi.org/10.21518/2079-701X-2019-6-34-40
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