Neuroprotective effects of meloxicam on transient brain ischemia in rats: the two faces of anti-inflammatory treatments

Musculoskeletal back pain (MSBP) is one of the  most  common  reasons  for seeking  medical  care. A socioeconomic burden  of MSBP is significant, as it leads  to reduced  working capacity of the adult  population.  It is important to consider  that  the MSBP chronicity develops  under the impact of “yellow flags”, i. e. factors that contribute to the central  pain sensitization (pathophysiologically) and pain chronicification  (clinically). The most common factor of pain chronicity is anxiety that underlies  the development  of pain  catastrophization, maladaptive escape  (“pain”)  behaviour,  and  anxiety  disorders.  Anxiety symptoms  can  be expressed not only in the emotional,  but also in the somatic, cognitive and behavioural sphere. Timely detection and management  of anxiety  in patients with  chronic MSBP improves  the  effectiveness of pain  syndrome  treatment. The chronic MSBP treatment requires  a multidisciplinary  approach,  which comprises  kinesiotherapy, cognitive  behavioural therapy, and optimal pharmacotherapy. Evidence-based drugs include  non-steroidal anti-inflammatory drugs, such as dexketoprofen, which can be prescribed  for the treatment of chronic MSBP with a short course and at an average  therapeutic dose. The efficacy and safety of dexketoprofen in the  treatment of pain syndromes, data  from clinical studies  and a systematic  review are discussed. The authors  present their own experience in managing  a patient  with chronic nonspecific MSBP and anxiety. The “yellow flags” that led to the MSBP chronicity in the patient  are provided. The effective  multidisciplinary  approach  to the treatment of a patient with chronic MSBP and anxiety disorder is demonstrated.

Management of patients with musculoskeletal back pain and comorbid anxiety

Since its introduction about a decade ago, the tension-free vaginal tape (TVT) operation has been the most widely used surgical procedure for treating women with stress urinary incontinence. Postoperative voiding dysfunction is reported in 1.5% to 14% of patients, and there is, as yet, no consensus on how best to manage those affected. The investigators reviewed 143 patients having a TVT procedure in the years 1998-2005. In all cases, it was the only surgery performed and was carried out as originally described by Ulmsten. No vaginal pack was used after the operation and, in the absence of bladder perforation, the catheter was removed at the end of surgery. If a bladder scan the next morning disclosed more than 100 mL of residual urine, the patient was asked to perform clean intermittent catheterization (CIC) at home. Prolonged voiding dysfunction was defined as a need for CIC for longer than 1-2 weeks postoperatively accompanied by a feeling of incomplete emptying. Three bladder perforations occurred, all of them within a year of introduction of the operation. Two of the 143 patients, 1.4% of the total, had stress incontinence 3 months postoperatively. Ten patients (7%) had prolonged voiding dysfunction despite a lack of intraoperative complications. Only one of them had a history of urogynecological surgery-an anterior repair. Urodynamic studies proved stress incontinence in all 10 patients. In five instances, the tape was pulled down by about 5 cm, and all these patients remained dry. Incontinence recurred in 2 patients when the tape was cut. Three patients performed CIC for periods ranging from 5 weeks to 9 months, but some degree of prolonged voiding and/or urgency persisted in all of them. When voiding dysfunction is present following the TVT procedure, the tape should be pulled down after 1 to 3 weeks. Cutting the tape entails a risk that incontinence will recur. Prolonged CIC may result in slow urine flow and a need for double voiding.

Treatment of prolonged voiding dysfunction after tension-free vaginal tape procedure

Pain syndromes, acute and chronic, against the background of inflammatory diseases (such as osteoarthritis (OA)), degenerative-dystrophic changes (involutive process, trauma) or systemic diseases (rheumatoid arthritis, etc.) dictate a steady increase in the intake of nonsteroidal anti-inflammatory drugs (NSAIDs). The choice of the most «safe NSAID» is based on the assessment of the toxicity index (the ratio when blocking cyclooxygenase (COX)) and the development of relative risks (the benefit/risk ratio). As well as those adverse events that can be detected with individual sensitivity to a specific NSAIDs, taking into account the anamnesis of previous diseases and intolerance to NSAIDs, existing chronic diseases (gastrointestinal tract, cardiovascular system, type 2 diabetes mellitus), limiting the appointment of NSAIDs. Considering these circumstances, the NSAID meloxicam (Amelotex) can be recommended for the treatment of various genesis pain syndromes. A number of studies have demonstrated the efficacy and safety of meloxicam with different methods of its administration (per oral (p/o), intramuscularly (i/m)) in the treatment of pain syndrome in the lower back, with OA, etc. Recent studies concern intravenous (i/v) meloxicam (30 mg) administration with moderate and severe postoperative pain syndrome. Today, the most commonly pain therapy scheme using meloxicam includes step-by-step administration of injectable and oral forms: meloxicam i/m (1.5 ml) for 3-5 days, followed by a transition to p/o (7.5-15 mg) intake for 14 days, or complex therapy with meloxicam (Amelotex), with muscle relaxant and B vitamins.

[Meloxicam clinical effects].

Introduction. Dorsalgia is one of the most common diseases in individuals practising regular physical training and sports Rationale. Because of the growth of the number of physically active individuals expected to rise by 2024, the improvement of drug and physical rehabilitation methods comes into sharp focus.The objective of the study is to evaluate the clinical efficacy of the use of a centrally acting muscle tolperisone-containing relaxant in the combined treatment of dorsalgia accompanied by a muscular tonic syndrome.Materials and methods. In the study, two groups of patients (30 people each) with muscular tonic syndrome received therapy that included NSAIDs and a neurotropic vitamin complex (in the comparison group), and additionally a centrally acting muscle relaxant (in the treatment group).The treatment outcome was assessed by changes in complaints and the objective neurological status of patients, the degree of muscle soreness upon palpation, and the evaluation of pain syndrome using a visual analogue scale.The shear wave elastography (SWE) of defunct muscles was used as an objective assessment method.Earlier in clinical practice, muscle tension in patients was usually assessed using manual palpation, i.e., only qualitatively and subjectively. SWE is an operator-independent, relatively reproducible, and quantitative method for assessing tendons and muscles. SWE was used in this study to obtain more objective assessment and comparison of the elasticity of “affected” and “healthy” symmetrical back muscles before and after the use of drugs.Results. The study showed a high clinical efficacy of tolperisone in the combination therapy of the lower back pain accompanied by muscular tonic syndrome, which was confirmed by a more significant decreased muscle-tonic syndrome based on the evaluation of complaints and the degree of muscle soreness upon palpation, a more pronounced regression of pain syndrome according to VAS in the treatment group of patients vs the comparison group. According to the elastography findings before and after treatment, the group receiving tolperisone showed a more significant decrease in muscular tonic syndrome.Сonclusion. The study confirmed the clinical efficacy of tolperisone manufactured by Sotex pharmaceutical company. On these grounds we recommend that the drug is used in combination therapy for dorsalgias (dorsopathies) accompanied by a muscular tonic (myofascial) syndrome both in patients without a proper level of physical activity, and in those practising regular physical training and sports. 

/pdf/tolperisone-in-the-combination-treatment-of-muscular-tonic-3kttmcrz0s.pdf

Tolperisone in the combination treatment of muscular tonic syndrome in individuals with a high level of physical activity

OBJECTIVE To compare the efficacy and tolerability of different combinations of domestic generics meloxicam (amelotex), tolperisone (calmirex) and B vitamins (compligam B) in the treatment of acute low-back pain. MATERIAL AND METHODS Ninety patients with acute low-back pain (ICD-10 M54.5) were studied. Indications and prescribing of the drugs was carried out under the international generic name. Pain was assessed using a visual analog pain scale in mm (VAS). To relieve pain, all patients received the non-steroidal anti-inflammatory drug with a favorable safety profile meloxicam (amelotex). With the aim of optimization, 3 therapy regimens were proposed: group 1 (n=30) received amelotex, calmirex, and B vitamins (compligam B). Group 2 (n=30) received amelotex and calmirex. Group 3 (n=30) was treated with amelotex and compligam B. With a decrease in pain by 50% or more from the baseline level and a VAS <40 mm, patients could reduce the dose of amelotex from 15 to 7.5 mg or stop taking it. RESULTS During treatment, all groups showed a significant regression of pain according to VAS: in group 1 from 77 to 9 mm, in group 2 from 74 to 12 mm, in group 3 from 69 to 14 mm. The maximum statistically significant reduction in pain and the degree of muscle tone was observed in group 1. Adverse reactions occurred in all groups, but they were weak and transient, and did not require correction or discontinuation of therapy. Only one patient from group 3 had a persistent rise in blood pressure. The average duration of temporary disability was 5.8 days in group 1, 7.4 in group 2, and 9.5 days in group 3. High efficacy and good tolerability of all 3 therapy regimens were noted. The combination of amelotex, calmirex and compligam B received the highest rating in the opinion of doctors and patients. CONCLUSION All 3 treatment regimens optimize therapy in patients with acute low-back pain, reduce the dose and timing of the NSAID administration as well as the risk of adverse reactions. The results indicate that the combination of amelotex, calmirex and compligam B is a synergy of three pain relief systems due to the effect on different pathogenetic mechanisms, thereby providing the maximum analgesic effect, shortening the course of treatment and duration of temporary disability, reducing the risk of relapse and chronicity of pain.

[The assessment of the clinical efficacy and tolerability of complex treatment of patients with acute low-back pain].

Objective: to evaluate the clinical efficacy and tolerability of the Russian drug tolperisone (calmyrex) versus tizanidine and baclofen in the therapy of acute nonspecific musculoskeletal pain (NSMSP) in the elderly. Patients and methods. Examinations were made in 135 elderly (60–75-year-old) patients with acute NSMSP. To relieve pain syndrome, all the patients were prescribed nimesulide suspension 100 mg twice a day after meals. The patients were randomized using an envelope method to three groups, each of which took a muscle relaxant as tablets for 15 days: Group 1 received the Russian drug tolperisone (calmyrex) 150 mg thrice a day; Group 2 used tizanidine 2 mg thrice a day; Group 3 had baclofen 10 mg twice a day. Pain syndrome was rated on a visual analogue scale (VAS). To measure orthostatic blood pressure, to check the coordinator system, and to record adverse events (AEs) were mandatory. Results and discussion. At 15 days, treatment substantially reversed pain syndrome according to VAS scores in all the groups: from 68 to 14 in Group 1, from 64 to 17 in Group 2, and from 62 to 18 in Group 3 (without significant differences between the groups). AEs were more common in Groups 2 and 3 patients who received tizanidine or baclofen. Orthostatic hypotension was reported in 3 patients taking baclofen. The high safety and good tolerability of a combination of a non-steroidal anti-inflammatory drug (NSAID) and a muscle relaxant were noted in the calmyrex group. Although muscle relaxants ensure clinically significant short-term pain relief in acute nonspecific back pain, it is necessary to take into account that elderly patient can develop AEs when taking the drugs, which is associated with delayed metabolic reactions, reduced hepatic blood flow and glomerular filtration rate, and a larger number of diseases and used medications. Conclusion. Therapy with NSAIDs and centrally acting muscle relaxants for acute NSMSP in elderly people calls for special precautions due to the fact that there may be AEs that are less likely to occur with calmyrex than with tizanidine and baclofen.

/pdf/comparative-efficacy-and-tolerance-of-centrally-acting-15wy0e4pfc.pdf

Comparative efficacy and tolerance of centrally acting muscle relaxants in elderly patients with nonspecific musculoskeletal pain

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[The assessment of the clinical efficacy and tolerability of complex treatment of patients with acute low-back pain].

Comparative efficacy and tolerance of centrally acting muscle relaxants in elderly patients with nonspecific musculoskeletal pain