Changes in management of patients with diseases of musculoskeletal system and joints

2021 ◽  
pp. 36-40
Author(s):  
A. L. Vertkin ◽  
A. N. Barinov ◽  
G. Yu. Knorring
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Severe Pain ◽  
Pain Syndrome ◽  
Cooperative Action ◽  
Pain Syndromes ◽  
Adequate Pain Relief ◽  
Inflammatory Drugs ◽  
Group B ◽  
Group B Vitamins

Pain syndrome accompanies the vast majority of diseases; therefore, the issues of adequate pain relief remain topical not only for urgent conditions, but also for everyday medical practice. Modern and changed in recent years approaches to the appointment of anesthetic therapy should take into account not only the pathogenetic mechanisms of the development of pain syndrome in a particular patient, but also the need to use drug combinations. This allows for the potentiation of the analgesic effect, reduction of effective dosages of individual drugs and minimization of side effects. In case of severe pain syndrome in the presence of signs of impaired nociception, neuropathic and muscle-fascial pain syndromes, the use of non-steroidal anti-inflammatory drugs in conjunction with group B vitamins is justified. The article considers the pathogenetic details of such a combination therapy, reveals the mechanisms of the cooperative action of the proposed combination of drugs.

Reducing pain in certain forms of obstetric pathology: nonsteroidal anti-inflammatory drugs (Сlinical lecture)

2017 ◽  
pp. 9-14
Author(s):  
L. Nazarenko ◽  
Keyword(s):  
Preterm Birth ◽  
Side Effects ◽  
Key Words ◽  
Clinical Efficacy ◽  
Premature Birth ◽  
Pain Syndrome ◽  
Inflammatory Drug ◽  
Threatened Abortion ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

The article discusses the pathogenetic basis for the use of non-steroidal anti-inflammatory drugs (NSPVP) in obstetric practice for the treatment of pain syndrome in women with threatened abortion and pathological preliminary period. Provided with modern views on the mechanisms of analgesic clinical efficacy, side effects NSPVP. Provides information about the place of NSPVP during pregnancy, the risks to the fetus, the positive aspects in the conduct of women at risk of preterm birth, the pathological preliminary period. Key words: nonsteroidal anti-inflammatory drug, pain, premature birth, preliminary period.

scholarly journals Efficacy of pollen extract in association with group B vitamins for pain relief in chronic prostatitis/chronic pelvic pain syndrome: A survey of urologists' knowledge about its clinical application

2017 ◽  
Vol 89 (1) ◽  
pp. 22 ◽  
Author(s):  
Giacomo Maria Pirola ◽  
Stefano Puliatti ◽  
Tommaso Bocchialini ◽  
Eugenio Martorana ◽  
Salvatore Micali ◽  
...  
Keyword(s):  
Chronic Prostatitis ◽  
Chronic Pelvic Pain ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
B Vitamins ◽  
Pelvic Pain Syndrome ◽  
Plant Product ◽  
Group B ◽  
Group B Vitamins

Introduction and aim of the study: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPSS) is a pathology of high prevalence in Italian male population, difficult to diagnose and to treat and with poor response to conventional therapy. Aim of this study was to review the evidence of the literature about the therapeutic effects of a plant product containing flower pollen extracts and group B vitamins on symptoms resolution and amelioration of CP/CPPS patients’ quality of life and to investigate the knowledge among practicing urologists about the clinical application of this product. Materials and methods: A group of 38 urologists was submitted to an investigational survey of the knowledge of the clinical applications of a plant product containing flower pollen extracts and group B vitamins Results: 71% of the urologists interviewed prescribed the plant product for CBP and CP/CPPS at least one time in a month and 11% prescribed it more than 5 times; 67% had evidence of clear ameliorations in pain relief and on patient's quality of life and 47% reported that the effectiveness is comparable to NSAIDs; 39% also reported a significant effect for the improvement of the urinary symptoms of patients. No gastric or general side effects have been noticed during the administration period of this plant product. Finally, the cost of the product has always reported to be sustainable for the patients. Conclusions: From the results of this investigational survey, we can state that the plant product containing flower pollen extracts and group B vitamins is well-known and demonstrated beneficial effects on symptoms resolution and amelioration of quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome.

scholarly journals On the mechanisms of the synergistic action of tolperisone, meloxicam and B vitamins in the treatment of peripheral pain syndromes

2020 ◽  
pp. 54-64
Author(s):  
O. A. Gromova ◽  
I. Yu. Torshin ◽  
M. V. Putilina ◽  
L. A. Maiorova ◽  
V. A. Semenov
Keyword(s):  
Molecular Mechanisms ◽  
Muscle Relaxants ◽  
B Vitamins ◽  
Neuroprotective Effects ◽  
Pain Syndromes ◽  
Peripheral Pain ◽  
Anti Inflammatory ◽  
Group B ◽  
Leukotriene A4 ◽  
Group B Vitamins

Introduction: The combined use of non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and group B vitamins is a promising direction for combined pharmacotherapy of peripheral pain syndromes.Purpose: to analyze the molecular mechanisms of the synergism of the muscle relaxant tolperisone, a non-steroidal anti-inflammatory drug meloxicam and vitamins B1, B6 and B12 as part of complex pharmacotherapy of pain.Materials and methods: differential chemoreactome analysis of NSAID molecules and muscle relaxants, proteomic analysis of the effects of B vitamins.Results: Synergistic interactions are maintained by (1) inhibiting cyclooxygenase-2 and leukotriene A4 hydrolases; (2) inhibition of the effects of IL-1β, TNFα, NF-kB, TLR4, RANKL, matrix metalloproteinases; (3) antioxidant effect (increased expression of superoxide dismutase-1 and glutathione peroxidase). Group B vitamins enhance the effects of tolperisone and meloxicam due to the manifestation of independent anti-inflammatory (neutralization of homocysteine, decreased expression of pro-inflammatory cytokines TNFα, IL-1b and factor NF-kB activity), analgesic (modulation of opioidergic pathways) and neuroprotective effects (support of amino acid expression, metabolism and neuro lipids, ATP synthesis and remyelination).Conclusions: The triple scheme “tolperisone + meloxicam + vitamins B1 / B6 / B12” is characterized by a number of undeniable advantages: (1) lack of dependence, (2) anti-inflammatory effect, (3) neuroprotective and remyelinating effects, (4) elimination of muscle hypertonicity. Such combination therapy can be used in patients of various age groups with comorbid conditions (diabetes mellitus, arterial hypertension, cerebrovascular diseases, gastrointestinal diseases) and does not require an increase in NSAIDs and significantly reduces the risk of side effects.

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 Combined therapy of pain syndromes: rationale and prospects for potentiation of effects

2020 ◽  
pp. 28-30
Author(s):  
G. Yu. Knorring ◽  
Z. K. Aliev
Keyword(s):  
Adverse Effects ◽  
Medical Practice ◽  
Skeletal Muscles ◽  
Myofascial Pain ◽  
Combined Therapy ◽  
Pain Syndrome ◽  
Myofascial Pain Syndromes ◽  
Pain Syndromes ◽  
Therapy Of Pain ◽  
Inflammatory Drugs

Pain syndrome accompanies absolute majority of diseases, therefore problems of adequate anesthesia remain acute not only for urgent conditions but also for everyday medical practice. Modern approaches of anesthetic therapy should consider not only pathogenic mechanisms of evolving pain syndrome by a certain patient but also necessity to administer drug combinations. It allows potentiating an analgesic effect, to decrease effective dosages of individual drugs and minimize adverse effects. The administration of non-steroidal anti-inflammatory drugs together with B vitamins and tolperisone is justified in a marked pain syndrome with a spastic component and/or spasms of skeletal muscles, muscle contractures, myofascial pain syndromes, as well in rehabilitation therapy after orthopedic and traumatology surgeries. The article considers pathogenic details of such combined therapy, discloses mechanism of synergic action of the proposed drug combination.

scholarly journals Medial Gamma Knife thalamotomy for intractable pain

2018 ◽  
Vol 129 (Suppl1) ◽  
pp. 72-76 ◽  
Author(s):  
Dusan Urgosik ◽  
Roman Liscak
Keyword(s):  
Pain Relief ◽  
Gamma Knife ◽  
Severe Pain ◽  
Radiation Treatment ◽  
Phantom Pain ◽  
Intractable Pain ◽  
Single Shot ◽  
Pain Syndromes ◽  
Constant Pain ◽  
Stereotactic Frame

OBJECTIVEAblative procedures are still useful in the treatment of intractable pain despite the proliferation of neuromodulation techniques. In the paper the authors present the results of Gamma Knife thalamotomy (GKT) in various pain syndromes.METHODSBetween 1996 and 2016, unilateral GKT was performed in 30 patients suffering from various severe pain syndromes in whom conservative treatment had failed. There were 20 women and 10 men in the study population, with a median age of 80 years (range 53–89 years). The pain syndromes consisted of 8 patients with classic treatment-resistant trigeminal neuralgia (TN), 6 with postherpetic TN, 5 with TN and constant pain, 1 with TN related to multiple sclerosis, 3 with trigeminal neuropathic pain, 4 with thalamic pain, 1 with phantom pain, 1 with causalgic pain, and 1 with facial pain. The median follow-up period was 24 months (range 12–180 months). Invasive procedures for pain release preceded GKT in 20 patients (microvascular decompression, glycerol rhizotomy, balloon microcompression, Gamma Knife irradiation of the trigeminal root, and radiofrequency thermolesion). The Leksell stereotactic frame, GammaPlan software, and T1- and T2-weighted sequences acquired at 1.5 T were used for localization of the targeted medial thalamus, namely the centromedian (CM) and parafascicularis (Pf) nucleus. The CM/Pf complex was localized 4–6 mm lateral to the wall of the third ventricle, 8 mm posterior to the midpoint, and 2–3 mm superior to the intercommissural line. GKT was performed using the Leksell Gamma Knife with an applied dose ranging from 145 to 150 Gy, with a single shot, 4-mm collimator. Pain relief after radiation treatment was evaluated. Decreased pain intensity to less than 50% of the previous level was considered successful.RESULTSInitial successful results were achieved in 13 (43.3%) of the patients, with complete pain relief in 1 of these patients. Relief was achieved after a median latency of 3 months (range 2–12 months). Pain recurred in 4 (31%) of 13 patients after a median latent interval of 24 months (range 22–30 months). No neurological deficits were observed.CONCLUSIONSThese results suggest that GKT in patients suffering from severe pain syndromes is a relatively successful and safe method that can be used even in severely affected patients. The only risk of GT for the patients in this study was failure of treatment, as no clinical side effects were observed.

Dendritic cell vaccine as an alternative to opioid analgesia in patients with advanced cervical cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18022-e18022
Author(s):  
Anna P. Menshenina ◽  
Oleg I. Kit ◽  
Elena M. Frantsiyants ◽  
Tatiana I. Moiseenko ◽  
Ekaterina V. Verenikina ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Pain Relief ◽  
Severe Pain ◽  
Pain Syndrome ◽  
Opioid Analgesics ◽  
Dendritic Cell Vaccine ◽  
Cell Vaccine ◽  
Advanced Cervical Cancer ◽  
Moderate Pain ◽  
Intense Pain

e18022 Background: Locally advanced and progressive cervical cancer is always accompanied by the pain syndrome. The common analgesics include non-steroidal anti-inflammatory drugs and opioids. The purpose of the study was to assess allogeneic dendritic cell vaccine (DCV) as an alternative analgesic in patients with advanced cervical cancer. Methods: The pain syndrome dynamics was assessed in 20 patients with advanced T3-4N1M0-1 cervical cancer receiving subcutaneous paravertebral injections of allogeneic DCV in a total alternating dose of 5-10 million cells every 2 weeks. Patients received DCV for one year, with a total of 24 vaccine therapy sessions and a total dosage of 180 million dendritic cells. The pain intensity was assessed on a verbal rating scale: 0 – no pain; 1 – mild pain; 2 – moderate pain; 3 – severe pain; 4 – extremely intense pain. Results: Prior to the therapy, 15 patients (75%) had severe pain; 2 (10%) - moderate pain; 3 (15%) - extremely intense pain. After 4-6 DCV injections, the pain intensity decreased, patients refused opioid analgesics. After 10-12 DCV sessions, 19 (95%) (p < 0.05) women had no pain at all, patients denied additional pain relief with non-opioid analgesics. Unrelieved pain was registered only in one cervical cancer patient. Conclusions: DCV injections in patients with advanced cervical cancer provide pain relief thereby improving their quality of life.

A comparative study of post-operative analgesia after caesarean section with intrathecal hyperbaric bupivacaine combined with different doses of buprenorphine

2021 ◽  
Vol 20 (1) ◽  
pp. 07-09
Author(s):  
Veereshkumar Angadi ◽  
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Post Operative Pain ◽  
Analgesia Requirement ◽  
Group A ◽  
Group B ◽  
Different Doses

Background: Post-operative pain relief after caeserean section is challenging to both anesthetista and obstetricians. Injection buprenorphine can be used intrathecally for post operative analgesia. Aim: the aim of the study was to compare the efficacy of two different doses(30ug and 60ug) of buprenorphine intrathecally with hyperbaric bupivacaine for post operative pain relief in caserean section. Methods and Materials: A prospective randomised controlled study was done on 60 subjects undergoing elective casarean section where in two groups were made, Group A (n=30) and Group B (n=30) who received inj bupivacaine 0.5% hyperbaric 2ml plus inj buprenorphine 30ug and inj bupivacaine 0.5% hyperbric plus inj buprinorphine 60ug intrathecally respectively. Following parameters were observed, onset and duration of sensory block, postopertive pain measured on VAS(visual analogue scale),rescue analgesia requirement, maternal side effects. Results: Unpaired t test and Chi square test were used for statistical analysis. Duration of analgesia was longer significantly in group A compared to group B. rescue analgesia requirement and VAS were significantly lower in group A as compared to group B.No major side effects were seen. Conclusion: Increasing the dosage of buprenorphine intrathecally increased the duration and quality of post operative analgesia. with no major adverse effects.

scholarly journals Intraperitoneal analgesia for postoperative pain relief after laparoscopic gynecological surgeries

2017 ◽  
Vol 6 (11) ◽  
pp. 5099 ◽  
Author(s):  
Basant Kumar Pati
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Visual Analogue Score ◽  
Local Anaesthetics ◽  
Safe Method ◽  
Analgesic Consumption ◽  
Post Operative Pain ◽  
Intraperitoneal Instillation ◽  
Group B

Background: Though laparoscopic gynaecological surgeries are less invasive and produces less post-operative pain, post-laparoscopy pain is still a concern. Intraperitoneal (IP) instillation of local anaesthetics has been shown to minimize the postoperative pain after laparoscopic surgeries. This study was conducted to compare the efficacy of intraperitoneal instillation of dexmedetomidine with bupivacaine and bupivacaine alone in reducing postoperative pain.Methods: 60 patients, enrolled for gynaecological laparoscopic surgeries were divided randomly into two groups of 30 each. Group B: Bupivacaine (30 ml, 0.25%) with 2 ml normal saline was instilled prior to removal of trocars, and Group BD: Bupivacaine (30 ml, 0.25%) with dexmedetomidine (1 mcg/kg, diluted to 2 ml) was instilled prior to removal of trocars. In postoperative period, Visual Analogue Score (VAS) was recorded up to 24 hours. Postoperative analgesic requirements, and side effects were recorded.Results: The Visual Analogue Score (VAS) during the first postoperative 24 hours was significantly lower in group BD compared to group B. Time to first analgesia required was delayed and total analgesic consumption was lower in group BD compared to group B which was statistically significant.Conclusions: Intraperitoneal instillation of dexmedetomidine with bupivacaine is an effective and safe method for reducing pain after laparoscopic gynaecological surgeries.

scholarly journals Water-Cooled Radiofrequency: A Neuroablative or a Neuromodulatory Modality with Broader Applications?

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Khalid Malik ◽  
Honorio T. Benzon ◽  
David Walega
Keyword(s):  
Pain Relief ◽  
Pulsed Radiofrequency ◽  
Neural Damage ◽  
Pain Syndromes ◽  
Adequate Pain Relief

We report the successful use of water-cooled radiofrequency where more traditional forms of neuroablation—conventional and pulsed radiofrequency—had failed to achieve adequate pain relief. We also discuss the mechanism of neural damage with water cooled radiofrequency and discuss why this technique may have a broader role in the management of a wide array of pain syndromes.

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