widespread LBP, including among young and middle
working age, makes a great socioeconomic importance
this problem. Therefore, among the priorities recommended by the WHO to
detailed study in the Bone and Joint Decade (The Bone and Joint Decade
20,002,010 years.) Covers and back pain (WHO, 1999).
Allocate Primary and secondary syndrome of LBP . Primary
syndrome often develops between the ages of 20 to 50 years. It is based on
mechanical factors: spondylosis and intervertebral osteochondrosis, dysfunction
myshechnosvyazochnogo apparatus back herniated disc. Persons under 20 years of age and older than 50 years
dominates the secondary syndrome LBP, the diagnosis is Hadler
proposes a set of symptoms indicators (Table 1).
Scheme 1. Role of cytokines in the development of pain syndrome in osteochondrosis
known that the basis of the so-called primary syndrome LBP is
osteochondrosis ( spondylosis) of the spine in conjunction with the musculo-ligamentous
disorders . Osteochondrosis - a degenerative disease of cartilage
with reactive changes of the vertebral bodies (spondylosis). Spondylarthrosis as
known, is a degenerative process which is localized in
intervertebral joints that are normal synovial joints with two
covered with hyaline cartilage joint surfaces. And hyaline (articular),
and fibrous (intervertebral disc - MTD) cartilages are composed of cells - chondrocytes,
synthesizing proteoglycans, and the intercellular substance (cartilage matrix).
has now been established that the MTD is a type of cartilage,
rich proteoglycans represented sulfated glyukozaminoglikanami
and collagen type I and II. Proteoglycans disc (nucleus pulposus and the fibrous ring
) are chondroitin sulfate, which are homologous proteoglycan
articular cartilage of peripheral joints. It is shown that the processes of degeneration in
intervertebral and peripheral joint pain in principle do not differ [3].
Clinically, the disease can occur acutely (up to 3 weeks), subacute (from 3 to 12 And
weeks) or chronic (more than 12ti weeks per year, or until 25ti
episodes of LBP earlier). There are 4 types of back pain: local, projection,
radicular (radicular) and pain arising from muscle spasm.
Many of the issues of diagnosis and treatment of LBP are not solved at all, or are at
under discussion and study. WHO obsuzhdaet following treatment of LBP:
1. Resolve the cause of back pain .
2. Rest for a few days (from 2 to 5).
3. Wearing a tie (lumbar corset is often, and in some cases
has been successfully used for back pain, but in 1999 formulated
position that from the point of evidence-based medicine is not received
evidence of the need to wear the tie, in connection with what is currently recommended to wear a corset
in acute and subacute period of illness, and in subsequent
only on doctor's advice).
4. Nonsteroidal anti-inflammatory dasgs (NSAIDs).
5. Muscle relaxants .
6. Local therapy: injections (anesthetics, corticosteroids),
ointments, acupuncture.
7. Manipulation .
8. Traction (from the perspective of evidence-based medicine there is no data on its effectiveness
unconditional).
9. Transcutaneous electroneurostimulation .
10. Exercise .
11. Physical therapy (phonophoresis,
синусоидальномодулированные currents, ultrasound, laseromagnetotherapy).
12. Surgical decompression .
13. Training programs for working with patients .
14. Psychological correction , especially in chronic
lumbalgia.
However, WHO experts emphasize that no manual therapy or physiotherapy,
any traction the spine from a position of evidence-based medicine have not justified.
Surgical decompression of the spine is an expensive method of treatment,
used only a small number of patients with complicated disease (herniated disc
, spinal stenosis, etc.), often associated with advanced stage
of osteochondrosis. In this regard, the development of new methods
conservative treatment of back pain is a challenging and urgent.
known that for many years with LBP, as well as in osteoarthritis,
recommended rest, physiotherapy and analgesics. However, in recent years has been
shown that the transmission of pain impulses from the affected degenerative process
pozvonochnodvigatelnogo segment (PDS) is synthesized
proinflammatory cytokines (IL1, IL6, TNF- a) with
formation of neurogenic inflammation on the ultrastasctural level [5].
also discussed and that the role of autoantigen in osteochondrosis of the spine acts
altered tissue of the intervertebral disc. Figure 1, we
attempted synthesis of accumulated data in the literature on the subject.
as seen from the scheme, in the process of degeneration of intervertebral disc
and activation of nociceptors appear biochemical and immune responses,
which ends in the formation of aseptic neurogenic inflammation in
resulting cytokine cascade at different levels.
gold standard among the NSAID is diclofenac (DF), combining in himself
high efficiency and safety. For all preparations of diclofenac
shown, moreover, no adverse effect on
metabolism of articular cartilage and, consequently, intervertebral disc,
related to cartilage tissue. In acute and subacute LBP highly effective
potassium salt of diclofenac Fahmy Rapid 50 mg 3 times a day
. Which, unlike conventional forms of DF quickly absorbed, providing
pronounced analgesic effect in 20-30 minutes.
We have studied the efficacy and tolerability of Rapti Rapida 20 patients with LBP
(12 women and 8 men) aged 34 to 72 years. The disease duration from 1
to 12 years (mean 5.3 years). In 12 patients diagnosed with chronic LBP
, 8 of acute and subacute.
Prior therapy consisted of diclofenac sodium (8 patients), ibuprofen (4),
paracetamol (2), indomethacin (4). Prior to receiving Fahmy Rapida above
NSAIDs have been canceled, and all patients the dasg was administered as monotherapy in 50
mg three times daily for 10 days.
Clinical efficacy was assessed on the following parameters:
All patients completed treatment Raptenom rapid speeds. Dynamics of clinical
indicators in 20 patients with back pain under the influence of therapy Raptenom Rapid
presented in Table 2.
It was found that all patients prior to treatment was observed
pain syndrome of different severity and averaged 3.4 points, morning stiffness
lasting 22 minutes, the nature of pain on McGill - 7,2 score
and the index of chronic disability in Vaddelyu - 5,6 points. After graduating
10-day course of treatment revealed a significant positive trend for all
evaluated clinical tests. Pain index dropped to 1.3 points,
duration of morning stiffness - up to 3.7 minutes. Significantly changed the nature of
pain (by pricking encompassing, painful to the weak or absent). Index
McGill dropped to 2.6 points. Also recorded marked reduction
index incapacity Vaddelyu - from 5,6 to 2,3 points. Evaluating the effectiveness of treatment
, held a physician, revealed significant improvement in 16 patients (80%).
satisfactory effect was observed in 2 patients (10%), and 2 patients (10%)
dasg was ineffective.
tolerability was generally good. Only 5 patients had
side effects in the form of epigastric pain, discomfort in the epigastric region
, heartburn, but they did not require discontinuation of therapy and were on their own.
So way, experience of the Rapti Rapida for LBP revealed his
clinical efficacy of 80% of patients . This is reflected in
a significant decrease in pain, increase range of motion
in the spine, as well as the positive dynamics of the other parameters to be estimated at
patients with back pain, which, combined with good tolerability
be recommended for the treatment of back pain, especially in acute and subacute
disease.
Literature:
1. Toroptsova NV, Benevolenskaya LI, Karyakin AN, Sergeev IL Clin.
Revmat., 1995, 5.2629.
2. Walsh A. Journ. of Epidemiology and Community Health, 1992,46, 227 230 pp.
3. WHO Department of noncomunicable disease management. Low back pain
iniciative. Geneve, 1999, 152 p.
Published with permission from Russian
Medical Journal.