Treatment of Chronic Pain

2003 ◽  
Vol 16 (4) ◽  
pp. 249-260 ◽  
Author(s):  
Virginia L. Ghafoor
Keyword(s):  
Chronic Pain ◽  
Clinical Trials ◽  
Cultural Differences ◽  
Best Practice ◽  
Clinical Presentation ◽  
Muscle Relaxants ◽  
Professional Organizations ◽  
Pharmacologic Therapy ◽  
Low Back ◽  
Inflammatory Drugs

Chronic pain is a symptom associated with ongoing physical or mental illness or a combination of both that may not have a clear, identifiable pathophysiology. Assessment of chronic pain varies in the clinical presentation related to age, gender, racial, and cultural differences. Headache, low back pain, musculoskeletal pain, and neuropathic pain are the most common types of chronic pain complaints by patients. Pharmacologic therapy is based on best practice standards, published clinical trials, and guidelines by professional organizations. Current medications reviewed include opioids, anticonvulsants, antidepressants, clonidine, local anesthetics, muscle relaxants, N-methyl-D-aspartate antagonists, and nonsteroidal anti-inflammatory drugs.

scholarly journals Clinical Trials, Potential Mechanisms, and Adverse Effects of Arnica as an Adjunct Medication for Pain Management

Medicines ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 58
Author(s):  
Amanda G. Smith ◽  
Victoria N. Miles ◽  
Deltrice T. Holmes ◽  
Xin Chen ◽  
Wei Lei
Keyword(s):  
Chronic Pain ◽  
Clinical Trials ◽  
Low Back Pain ◽  
Pain Management ◽  
Biological Activities ◽  
Chemical Components ◽  
Low Back ◽  
Chronic Pain Management ◽  
Medical Benefits ◽  
Post Operation

Arnica has traditionally been used in treating numerous medical conditions, including inflammation and pain. This review aims to summarize the results of studies testing Arnica products for pain management under different conditions, including post-operation, arthritis, low back pain, and other types of musculoskeletal pain. Based on data from clinical trials, Arnica extract or gel/cream containing Arnica extract shows promising effects for pain relief. These medical benefits of Arnica may be attributed to its chemical components, with demonstrated anti-inflammatory, antioxidant, anti-microbial, and other biological activities. In conclusion, Arnica could be an adjunct therapeutical approach for acute and chronic pain management.

scholarly journals Factors influencing the efficacy of nonsteroidal anti-inflammatory drugs for acute low back pain. The results of the multicenter observational «CARAMBOL» (Clinical Analysis of Results of Analgesia by Meloxicam and its Safety in Acute Lumbodynia) study

2019 ◽  
Vol 13 (2) ◽  
pp. 31-37
Author(s):  
A. E. Karateev ◽  
A. M. Lila ◽  
E. Yu. Pogozheva ◽  
E. S. Filatova ◽  
V. N. Amirdzhanova
Keyword(s):  
Low Back Pain ◽  
Treatment Outcome ◽  
Pain Relief ◽  
Severe Pain ◽  
Muscle Relaxants ◽  
B Vitamins ◽  
Low Back ◽  
Factors Influencing ◽  
Inflammatory Drugs ◽  
Pain At Rest

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a main tool to treat acute nonspecific low back pain (NLBP). However, no factors that influence the efficacy of these drugs have been identified to the present day.Objective: to evaluate the therapeutic effect of and tolerance to NSAIDs (meloxicam) in treating acute NLBS and to identify the factors influencing the efficacy of this drug.Patients and methods. A study group consisted of 2078 patients (mean age 46.3±13.4 years; women 56.6%) with acute NLBS who had been treated in real clinical practice. The level of pain was estimated using a 0–10 point numerical rating scale (NRS). Initially, the pain level averaged 6.69±1.65 scores; 57.0% of patients were noted to have severe pain (≥7 NRS scores). Pain at rest persisted in 32.0% of patients; that at night was in 19.0%; sensation of stiffness in 60.7%, irradiation to the leg in 28.2%, and lumbar ischialgia in 9.6%. 70.2% of patients had been previously treated with NSAIDs for NLBS, while only 28.0% rated their efficacy as good. All the patients were prescribed meloxicam at a dose of 15 mg/day for a period of up to 2 weeks. 86.1% of the patients received meloxicam intramuscular for 2 days, then orally; 13.9% took the drug only orally. 52.3% of the patients also used muscle relaxants; 17.4% received oral or intramuscular B vitamins. The study estimated the rate of complete pain relief when NSAIDs were used for up to 2 weeks.Results and discussion. Complete pain relief was achieved in 75.2% of patients. 83.7% of patients rated the effect of treatment as good or excellent. Undesired drug reactions were recorded in 4.6% of patients. Female gender had no effect on treatment outcome (odds ratio (OR)=0.967; 95% confidence interval (CI), 0.795–1.177; p=0.763). Age over 65 years, the first NLBS episode, and a good NSAID effect in a history were associated with the best treatment result: OR=2.053 (95% CI, 1.5920–2.642), p<0.001; 1.415 (1.09–1.836), p=0.009; and 1.937 (1.513–2.481), p<0.001, respectively. Severe pain (≥7 NRS scores), persistent pain at rest and at night, and especially lumbar ischialgia indicated the worst result: OR=0.481 (95% CI, 0.393–0.588), p<0.001; 0.559 (0.441–0.709), p<0.001; 0.511 (0.413–0.631), p<0.001; and 0.346 (0.256–0.466), p<0.001, respectively. NSAIDs in combination with muscle relaxants and B vitamins versus NSAID monotherapy did not increase the likelihood of pain relief: OR=0.827 (95% CI, 0.594–0.889), p=0.02 and 0.917 (0.804–1.1201), p=0.452, respectively.Conclusion. Meloxicam at a dose of 15 mg/day is an effective and safe drug to treat acute NLBS. Patient gender has no effect on treatment outcome. Age over 65 years, the first NLBS episode, and a good response to NSAIDs in a history are associated with the best treatment results; and severe pain, persistent pain at rest and at night, irradiation to the leg, and lumbar ischialgia are related to the worst result. NSAIDs in combination with muscle relaxants and B vitamins did not improve treatment outcomes. 

scholarly journals Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis

2021 ◽  
pp. bjsports-2020-103596
Author(s):  
Silvia Gianola ◽  
Silvia Bargeri ◽  
Gabriele Del Castillo ◽  
Davide Corbetta ◽  
Andrea Turolla ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Meta Analysis ◽  
Muscle Relaxants ◽  
Low Back ◽  
Eligibility Criteria ◽  
Experienced Pain ◽  
Inflammatory Drugs

ObjectiveTo assess the effectiveness of interventions for acute and subacute non-specific low back pain (NS-LBP) based on pain and disability outcomes.DesignA systematic review of the literature with network meta-analysis.Data sourcesMedline, Embase and CENTRAL databases were searched from inception until 17 October 2020.Eligibility criteria for selecting studiesRandomised clinical trials (RCTs) involving adults with NS-LBP who experienced pain for less than 6 weeks (acute) or between 6 and 12 weeks (subacute).ResultsForty-six RCTs (n=8765) were included; risk of bias was low in 9 trials (19.6%), unclear in 20 (43.5%), and high in 17 (36.9%). At immediate-term follow-up, for pain decrease, the most efficacious treatments against an inert therapy were: exercise (standardised mean difference (SMD) −1.40; 95% confidence interval (CI) −2.41 to –0.40), heat wrap (SMD −1.38; 95% CI −2.60 to –0.17), opioids (SMD −0.86; 95% CI −1.62 to –0.10), manual therapy (SMD −0.72; 95% CI −1.40 to –0.04) and non-steroidal anti-inflammatory drugs (NSAIDs) (SMD −0.53; 95% CI −0.97 to –0.09). Similar findings were confirmed for disability reduction in non-pharmacological and pharmacological networks, including muscle relaxants (SMD -0.24; 95% CI -0.43 to -0.04). Mild or moderate adverse events were reported in the opioids (65.7%), NSAIDs (54.3%) and steroids (46.9%) trial arms.ConclusionWith uncertainty of evidence, NS-LBP should be managed with non-pharmacological treatments which seem to mitigate pain and disability at immediate-term. Among pharmacological interventions, NSAIDs and muscle relaxants appear to offer the best harm–benefit balance.

scholarly journals Tolperisone in the treatment of acute and chronic nonspecific back pain

2020 ◽  
Vol 12 (4) ◽  
pp. 137-142
Author(s):  
V. A. Golovacheva ◽  
A. A. Golovacheva ◽  
O. E. Zinovyeva ◽  
V. L. Golubev
Keyword(s):  
Clinical Trials ◽  
Back Pain ◽  
Randomized Trial ◽  
Muscle Relaxant ◽  
Large Scale ◽  
Muscle Relaxants ◽  
Good Tolerance ◽  
Vertebral Canal ◽  
Canal Stenosis ◽  
Inflammatory Drugs

Nonspecific back pain (NBP) is one of the most common reasons to see a neurologist or therapist. Acute (<4 weeks' duration), subacute (4 to 12 weeks), and chronic (>12 weeks) NBPs are recognized. The diagnosis of NBP is based on anamnestic data, somatic, neurological, and neurologic-and-orthopedic examination findings and on the exclusion of the specific causes of back pain, discogenic radiculopathy, and vertebral canal stenosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are used in the pharmacotherapy of acute, subacute, and chronic NBP. Tolperisone is widely used as a muscle relaxant in Russia and in the countries of Europe and Asia. Clinical trials have shown the efficacy and good tolerance of tolperisone used alone and in combination with NSAIDs for NBP. The review presents clinical recommendations from different countries on the use of muscle relaxants in the treatment of acute and chronic NBP. It is concluded that a large-scale qualitative randomized trial should be conducted to investigate the efficacy of muscle relaxants, tolperisone in particular, in the treatment of acute, subacute, and chronic NBP.

Non-Opioid Pharmacotherapies for Chronic Pain (DRAFT)

2018 ◽  
Author(s):  
James A. D. Otis
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Local Anesthetic ◽  
Tricyclic Antidepressants ◽  
Trigger Point ◽  
Muscle Relaxants ◽  
Adrenergic Agonists ◽  
Anesthetic Agents ◽  
Spinal Injections ◽  
Inflammatory Drugs

The objective of chapter 15 is to describe analgesic approaches to chronic pain, excluding opioids. As such, it emphasizes, first, the available pharmacotherapies; and then procedures. The pharmacotherapies divide into analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs); adjuvant analgesics, such as tricyclic antidepressants and anticonvulsants; oral anesthetic agents (cardiotropics); adrenergic agonists; topical agents such as capsaicin and local anesthetic solutions and ointments; and muscle relaxants such as cyclobenzaprine, tizanidine, and baclofen. Interventions include many best administered by anesthesiologists such as infusions of anesthetic agents; trigger point injections; local and regional blockade, spinal injections including corticosteroids; and electrical spinal cord stimulation. A text box is provided with additional resources.

scholarly journals Sacroiliac joint dysfunction: clinical presentations, diagnosis, treatment

2019 ◽  
Vol 11 (2S) ◽  
pp. 62-68 ◽  
Author(s):  
A. I. Isaikin ◽  
A. V. Kavelina ◽  
Yu. M. Shor ◽  
P. A. Merbaum ◽  
T. I. Shadyzheva
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Muscle Relaxant ◽  
Local Anesthetics ◽  
Sacroiliac Joint ◽  
Muscle Relaxants ◽  
Multimodal Approach ◽  
Clinical Presentations ◽  
Psychotherapeutic Techniques ◽  
Inflammatory Drugs

One of the most common anatomical sources of nonspecific back pain is sacroiliac joint (SIJ) injury. The paper gives data on the structure, features of diagnosis and treatment of pain caused by SIJ dysfunction. A multimodal approach, including psychotherapeutic techniques, kinesiotherapy, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants, is recommended for chronic pain. The authors give their own experience with drug treatment of 51 patients (36 women and 15 men; mean age, 56.4±2.1 years) with SIJ dysfunction, by using periarticular blockages with local anesthetics and glucocorticoids or radiofrequency SIJ denervation. They note the efficiency of using Airtal® as a NSAID and Mydocalm® as a muscle relaxant.

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