The resolution of the expert council is devoted to discussing aspects of the use of ipidacrine for the treatment of mononeuropathies, polyneuropathies and radiculopathies of various etiologies. Specialists prepared recommendations for ipidacrine's application in treating peripheral nervous system disorders.

The expert consensus is aimed to develop an algorithm for the diagnosis and treatment of mononeuropathies for outpatient neurologists. Leading experts in the field of neurology have suggested workup options for certain types of tunnel mononeuropathies based on current data on the effectiveness and safety of various types of conservative and surgical treatment.

Chronic shoulder pain (CSP) is a clinical syndrome associated with inflammatory and degenerative musculoskeletal changes, characterized by pain in the shoulder that persists for at least 3 months, arising or aggravated by functional activity in this area. The frequency of CSP in the modern population reaches 20–33%, it is one of the leading causes of severe suffering, disability and seeking for medical attention. The main causes of CSP are shoulder rotator impingement syndrome (subacromial impingement syndrome), calcific tendinitis, adhesive capsulitis, shoulder and acromioclavicular joint osteoarthritis. Accurate diagnosis of these diseases is necessary for the correct choice of treatment. Differential diagnosis is carried out using tests that evaluate the function of the shoulder joint and the rotator cuff muscles (Neer, Speed, Hawkins tests, etc.), as well as using instrumental methods (ultrasound, magnetic resonance tomography, X-ray). In CSP, it is necessary to exclude septic, oncological, visceral, systemic rheumatic and other diseases, as well as musculoskeletal pathology of the cervical spine, upper chest and back, which can cause pain in the shoulder region. Therapy for diseases that cause CSP should be personalized and complex, aimed at maximum pain control and restoration of function. For this purpose, non-steroidal anti-inflammatory drugs, local injection therapy with glucocorticoids, hyaluronic acid, and platelet-rich plasma are used. In some cases, muscle relaxants, antidepressants, anticonvulsants, local injections of botulinum toxin type A are indicated. Physiotherapy and medical rehabilitation methods play a fundamental role in the treatment of CSP.

Neck pain (NP) is one of the most common complaints of patients in outpatient practice and is predominantly non-specific (musculoskeletal) in nature. When examining a patient with NP, it is necessary to rule out a specific cause of the condition. The diagnosis of nonspecific NP (NNP) is based on a clinical examination that excludes signs of specific NP (“red flags”). If there are no signs of specific NP (“red flags”), early (in the first 4 weeks) magnetic resonance imaging is not indicated. It is recommended to inform the patient with NNP about the favorable prognosis of the disease, its risk factors, avoidance of prolonged excessive static and physical activity, incorrect (non-physiological) positions and postures, the effectiveness of therapeutic exercises (kinesiotherapy) and the advisability of maintaining physical activity. Non-steroidal anti-inflammatory drugs and muscle relaxants can be used to relieve NNP. For subacute and chronic NNP, kinesiotherapy, manual therapy in combination with psychological therapy methods (for depressive and anxiety disorders, pain catastrophizing, pain behavior), and antidepressants are recommended. Radiofrequency denervation may be effective for chronic NNP associated with cervical facet joint pathology. There are no convincing data on the efficacy of electrotherapy, ultrasound, traction, and wearing a cervical collar in the absence of orthopedic indications. For preventive treatment of NNP, kinesiotherapy and an educational program to avoid excessive static and physical activity, incorrect positions and postures are recommended. The issues of duration and frequency of therapeutic exercises for the treatment and prevention of NNP need further investigation.

Aim: to analyze the efficacy (time of onset, severity and duration of pain relief) and safety of a nonsteroidal anti-inflammatory drug (NSAID), Rakstan-sanovel (flurbiprofen; further Rakstan), in the complex treatment of patients with acute LBP. Patients and Methods: the study involved 210 patients with acute LBP, randomly divided into 2 similar groups of 105 subjects. In the control group (CG), a standard treatment regimen was used for two consecutive weeks. Drug therapy included any NSAID (except Rakstan), muscle relaxants, B vitamins in the doses recommended in the patient information leaflet. Non-drug therapy included physical exercise or physiotherapy (patients could receive one of these treatments or a combination of them) as determined by the doctor. In the main group (MG), Rakstan was used to relieve pain in combination with other necessary concomitant therapy (muscle relaxants, B vitamins, physical exercise and physiotherapy). The tendency of clinical condition was analyzed according to the following scales: VAS, Roland-Morris Disability Questionnaire, CGI (to assess the overall clinical impression of the doctor and the patient), EQ-5D-5L. The total duration of drug intake follow- up was 10 days, as well as 2 subsequent weeks. Results: the majority of patients were female (the quantitative proportion of male and female was 1:1,4); the average age was 43.5 [29; 57] years with a disease duration of 14.4±6.3 days. Lumbar spondylosis was the predominant trigger of pain in 105 (50%) patients, sacroiliac joint injury — in 39 (18.6%), degenerative-dystrophic changes of the intervertebral disc — in 66 (31.4%). The majority (68%) of patients in both groups had a moderate pain level with a score of 45–74 points according to the VAS. By the end of the therapy course, the average difference between groups according to VAS was 19 points. By the end of the therapy course, 90% of patients with MG had reached a zero level of pain according to VAS, while in CG — only 50%. Besides, 2 weeks after the end of treatment, no pain recurrence was registered in the MG, and there was an improvement equaled 69% (41.6 points) in the assessment of the functional state according to the Roland-Morris Disability Questionnaire in the MG, while in the CG it reached only 24% (14.3 points). Assessment of the general clinical impression of the doctor according to the CGI questionnaire in the MG showed that 86 out of 105 patients rated their condition as "completely normal", while in the CG only 1 patient gave such an assessment. Adverse events (nausea, stomach pain, dizziness, diarrhea) were noted in 4 patients of the CG. Conclusions: the use of Rakstan allows to accelerate the recovery of patients with acute LBP without the development of additional adverse events, which may have a significant benefit in rational therapy, as well as in the prevention of chronification and relapses in patients of this category. KEYWORDS: acute lower back pain, non-steroidal anti-inflammatory drugs, flurbiprofen, Rakstan, recurrence. FOR CITATION: Danilov A.B., Merkulova D.M., Zhivolupov S.A. et al. Clinical efficacy and safety of the Rakstan-Sanovel in patients with acute low back pain (results of a multicenter postmarketing observational study). Russian Medical Inquiry. 2022;6(10):541–550 (in Russ.). DOI: 10.32364/2587-6821-2022-6-10-541-550.

В статье представлены результаты Российского мультицентрового статистического исследования NEODOLEX эффективности и переносимости препарата Неодолпассе, представляющего собой фиксированную комбинацию нестероидного противовоспалительного препарата (НПВП) диклофенака (75 мг) и мышечного релаксанта центрального действия орфенадрина (30 мг) при лечении острого болевого синдрома у пациентов с неспецифической болью в спине (НБС) и радикулопатией (РП). Проведенное исследование показало, что внутривенные инфузии Неодолпассе приводят к быстрому (через 24 ч) и значительному (более 50%) регрессу болевого синдрома у 94% пациентов. В зависимости от кратности введения Неодолпассе дополнительное применение других анальгетиков потребовалось у 21—35% пациентов с НБС и у 11—17% пациентов с РП. Обсуждаются потенцирующие и аддитивные взаимодействия диклофенака и орфенадрина, позволяющие добиваться эффективного обезболивания при использовании данной фиксированной комбинации. Отмечена хорошая переносимость двухдневного курса терапии и высокая оценка пациентами проведенного лечения.

Боль в спине (БС) относится к числу наиболее актуальных медицинских и социальных проблем. Она занимает одно из первых мест среди причин временной и стойкой потери трудоспособности и обращения за медицинской помощью. Ведение пациентов с болью в спине требует дифференцированного подхода и во многих случаях совместных усилий врачей различных медицинских специальностей.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are used orally or intramuscularly (IM) to treat lumbar ischialgia caused by musculoskeletal disorders or radiculopathy. A comparative study has been conducted to investigate the efficacy and safety of the NSAID meloxicam (Amelotex®) injected intramuscularly and into the trigger points in combination with tolperisone and B-group vitamins for lumbar ischialgia.Patients and methods. The investigation enrolled 62 patients aged 30–60 years with lumbar ischialgia, who were randomized into three equal groups. Group 1 patients were injected with meloxicam 1.5 ml (15 mg of its active ingredient) into the trigger points daily for 3 days, followed by one 15-mg tablet daily for 14 days; Group 2 received IM meloxicam 15 mg daily for 3 days, followed by one 15-mg tablet daily for 14 days; Group 3 had IM meloxicam 15 mg daily for 3 days, followed by one 15-mg tablet daily for 14 days in combination with tolperisone (Calmirex®) as tablets: 150 mg (Day 1 of therapy), 300 mg (Day 2), and 450 mg daily (Day 3 until the end of therapy). All the patients received IM Vitamin B complex (Compligam B®) 2 ml for 5 days. The treatment efficiency was evaluated using the pain visual analogue scale (VAS), the Oswestry disability questionnaire, and the McGill pain questionnaire, the range of motion, and the severity of neurodystrophic syndrome.Results and discussion. All the patient groups showed a rapid and substantial pain reduction on the VAS and a functional activity improvement according to the Oswestry scale, which made it possible to complete the treatment within an average of 9.6 days. Groups 3 and 1 exhibited a faster improvement and, as a result, a shorter therapy duration on 8.6±1.2 and 9.2±0.9 days than did Group 2 (8.6±1.2 days). On day 2 of treatment, there was a more considerable pain reduction on the VAS in Group 1 that received meloxicam injections into the trigger zones. The administration of meloxicam intramuscularly and into the trigger zones in combination with tolperisone and vitamin B complex was noted to be safe and well tolerated.Conclusion. The injection of Amelotex into the trigger zones is highly effective and safe in treating lumbar ischialgia. An NSAID (meloxicam) in combination with a muscle relaxant (tolperisone) speeds up recovery and shortens the duration of NSAID intake.

Introduction. Spondylogenic back pain is common in the working-age population and often results in a working disability. In order to ensure professional decision-making and inform preventive measures, occupational risk factors for low back pain (LBP) need to be identified. Material and methods. Using a regular medical check-up examination data, we analyzed the prevalence and the odds ratio of LBP in 3215 individuals working in physically demanding jobs and exposed to physical inactivity and vibration. Results. No statistically significant differences in LBP prevalence were found between workers exposed to low total physical activity (PA), in and out of work, and those exposed to physical overwork (38.9% и 33.8% respectively). Physical inactivity in the workplace and hypodynamia during leisure-time cause similar effects and increase the risk of LBP by 1.5 times. A combination of occupational factors such as a constrained posture (class 3.1-3.2 according to the National Labor Legislation) and whole-body vibration increases LBP risk up to 78.7%. Whereas the combination of a constrained posture, prolonged sedentary position, and whole-body vibration, increases LBP prevalence up to 84.21% (OR: 80). Conclusions. The highest risk of LBP (OR: 80.0) was assigned to the combination of constrained posture, prolonged sedentary position, and whole-body vibration. The obtained data suggest that both low PA and physical overwork increase the risk of LBP, whereas moderate PA reduces it.

When examining a patient with lumbosacral pain, it is necessary to rule out the specific cause of the disease. The diagnosis of discogenic lumbosacral radiculopathy (DLSR) is based on clinical examination; magnetic resonance imaging (MRI) is of informative value in excluding other causes of radiculopathy and in evaluating disk herniation. If the signs of cauda equina and spinal cord compression are absent, and no epidural glucocorticoid injection or urgent surgical treatment is scheduled, there is no reason for early (within the first 4 weeks) MRI.It is recommended to inform the patient with DLSR about the possibility of disk herniation regression and natural recovery and about the advisability of maintaining physical activity. Epidural administration of local anesthetics and glucocorticoids and use of non-steroidal anti-inflammatory drugs are advisable to relieve acute pain. Anticonvulsants (pregabalin and gabapentin), muscle relaxants, and B vitamins can be used as additional methods for acute DLSR; psychological therapies (cognitive behavioral therapy), antidepressants, therapeutic exercises (kinesiotherapy), manual therapy, and acupuncture are effective in chronic DLSR. Consultation with a neurosurgeon for possible microdiscectomy is indicated in the presence of cauda equina syndrome (urgently) and in the absence of medical therapy effects within 4–8 weeks.Therapeutic exercises (kinesitherapy) with an educational program for prevention of strenuous physical activity and static and uncomfortable positions for a long time, as well as for teaching how to lift weights properly, etc. are recommended for preventive purposes.

Examination of a patient with chronic low back pain (LBP) is aimed at eliminating its specific cause and assessing the social and psychological factors of chronic pain. The diagnosis of chronic nonspecific (musculoskeletal) LBP is based on the exclusion of a specific cause of pain, discogenic radiculopathy, and lumbar stenosis. It is advisable to identify possible pain sources: pathology of intervertebral disc pathology, facet joints, and sacroiliac joint and myofascial syndrome.An integrated multidisciplinary approach (a high level of evidence), including therapeutic exercises, physical activity optimization, psychological treatments (cognitive behavioral therapy), an educational program (back pain school for patients), and manual therapy, is effective in treating chronic musculoskeletal LBP. For pain relief, one may use nonsteroidal anti-inflammatory drugs in minimally effective doses and in a short cycle, muscle relaxants, and a capsaicin patch, and, if there is depressive disorder, antidepressants (a medium level of evidence). Radiofrequency denervation or therapeutic blockages with anesthetics and glucocorticoids (damage to the facet joints, sacroiliac joint), back massage, and acupuncture (a low level of evidence) may be used in some patients.Therapeutic exercises and an educational program (the prevention of excessive loads and prolonged static and uncomfortable postures and the use of correct methods for lifting weights, etc.) are recommended for preventive purposes.

The examination of a patient with acute low back pain (LBP) includes the clarification of complaints and history data, brief physical and neurological examinations, and an assessment of danger symptoms. The diagnosis of acute nonspecific (musculoskeletal) LBP is based on the exclusion of a specific cause of pain (a potentially dangerous disease), discogenic radiculopathy, and lumbar spinal stenosis. If there is typical musculoskeletal pain and no danger symptoms, radiography, X-ray computed tomography, and magnetic resonance imaging are not recommended in the first 4 weeks of disease. Whether it is expedient to perform these techniques is considered when LBP persists over this time period. A patient with acute nonspecific (musculoskeletal) LBP should be informed about the favorable outcome of the disease and the need to maintain physical and social activities, to avoid bed rest, and, if possible, to continue professional activities. The lowest effective dose of nonsteroidal anti-inflammatory drugs for short-term duration, as well as muscle relaxants (the medium level of evidence) can be used to relieve pain. It is recommended that one should use an educational program (to prevent over-exercising and prolonged standing or sitting in static and awkward positions; to lift weights properly; etc.) to prevent recurrent LBP, as well as therapeutic exercises during a non-exacerbation period.

To enhance the efficacy and safety of nonsteroidal anti-inflammatory drugs (NSAIDs), a class of essential medications used to treat acute and chronic pain, is an important and urgent task. For its solution, in 2015 Russian experts provided an NSAID selection algorithm based on the assessment of risk factors (RFs) for drug-induced complications and on the prescription of drugs with the least negative effect on the gastrointestinal tract and cardiovascular system. The PRINCIPLE project was implemented to test the effectiveness of this algorithm.Subjects and methods. A study group consisted of 439 patients (65% were women and 35% – men; their mean age was 51.3±14.4 years) with severe musculoskeletal pain, who were prescribed NSAIDs by using the above algorithm. The majority of patients were noted to have RFs: gastrointestinal and cardiovascular ones in 62 and 88% of the patients, respectively. Given the RF, eight NSAIDs were used; these were aceclofenac, diclofenac, ibuprofen, ketoprofen, meloxicam, naproxen, nimesulide, and celecoxib, the latter being prescribed most commonly (in 57.4% of cases). NSAID was used in combination with proton pump inhibitors in 30.2% of the patients. The follow-up period was 28 days. The investigators evaluated the efficacy of therapy (pain changes on a 10-point numeric rating scale (NRS)) and the development of adverse events (AE). Results and discussion. Pain was completely relieved in the overwhelming majority (94.9%) of patients. There were no significant differences in the efficacy of different NSAIDs according to NRS scores. The number of AE was minimal and did not differ between different NSAIDs, with the exception of a higher frequency of dyspepsia caused by diclofenac (15.7%). There were no serious complications or therapy discontinuation because of AE.Conclusion. The use of the NSAID selection algorithm allows for effective and relatively safe therapy with these drugs in real clinical practice.