Possibilities of pain syndrome therapy in patients with diabetes mellitus
DOI: 10.32364/2587-6821-2021-5-5-307-315
O.A. Shavlovskaya1, I.A. Bokova2, N.I. Shavlovsky2, Yu.D. Yukhnovskaya2
1International University of Rehabilitation Medicine, Moscow, Russian Federation
2I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow,
Russian Federation
The prevalence of lower back pain (LBP) in type 2 diabetes mellitus (DM2) is almost 2 times higher than in the similar control group (by age and gender). The association of DM2 with the severity, chronicity and recurrence of LBP was revealed. DM2 duration correlates with the severity and prevalence of degenerative-dystrophic changes. The representation of concomitant somatic pathology in patients with DM2 is significantly higher than in patients without DM2. Rational selection of the therapy regimen for LBP should be based on comorbid pathology. The molecular mechanisms of synergism of muscle relaxant (tolperizone), nonsteroidal anti-inflammatory drug (NSAID) (meloxicam), and B vitamins as part of complex pharmacotherapy of pain were analyzed. This treatment regimen has a number of benefits: lack of dependence, anti-inflammatory effect, neuroprotective and remyelinating effect, reduction of muscular hypertonus. A number of studies have shown the efficacy of such combination th erapy in patients of different age groups with comorbid conditions. It does not require an increase in NSAID doses and significantly reduces the risk of adverse events (AE). The applied treatment regimen is a combination of a muscle relaxant (tolperizone), NSAID (meloxicam) and a complex of B vitamins has already demonstrated its efficacy in the treatment of LBP in patients with comorbid diseases, according to the effect on the inflammatory process indicators (in the absence of AE).
Keywords: diabetes mellitus, lower back pain, body mass index, nonsteroidal anti-inflammatory drugs, meloxicam, muscle relaxants, tolperizone, B vitamins.
For citation: Shavlovskaya O.A., Bokova I.A., Shavlovsky N.I., Yukhnovskaya Yu.D. Possibilities of pain syndrome therapy in patients with diabetes mellitus. Russian Medical Inquiry. 2021;5(5):307–315 (in Russ.). DOI: 10.32364/2587-6821-2021-5-5-307-315.
Acknowledgement
The technical edition is supported by Solopharm.
About the authors:
Olga A. Shavlovskaya — Dr. Sc. (Med.), Professor of the Department of Organization of Medical Rehabilitation and Sanatorium Treatment, International University of Rehabilitation Medicine; 8/2, Furmanny lane, Moscow, 105062, Russian Federation; ORCID iD 0000-0003-3726-0730.
Irina A. Bokova — C. Sc. (Med.), Associate Professor of the Department of Restorative Medicine, Rehabilitation and Balneology, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8 bld. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0002-1640-1605.
Nikita I. Shavlovsky — 5th-year student, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8 bld. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0002-8673-3146.
Yulia D. Yukhnovskaya — 5th-year student, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8 bld. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0002-0928-2054.
Contact information: Olga A. Shavlovskaya, e-mail: shavlovskaya@1msmu.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 19.07.2021.
Revised 02.08.2021.
Accepted 16.08.2021.
2. Liu X., Pan F., Ba Z. et al. The potential effect of type 2 diabetes mellitus on lumbar disc degeneration: a retrospective single-center study. Journal of Orthopaedic Surgery and Research. 2018;13(1):52. DOI: 10.1186/s13018-018-0755-8.
3. Fursov A.B., Fursov R.A., Ospanov O.B. Inpatient Diabetes Care Standards: An Evolution of Perspectives from Glycemic Control to Metabolic Surgery. RMJ. Medical Review. 2020;4(6):340–346 (in Russ.). DOI: 10.32364 / 2587-6821-2020-4-6-340-346.
4. Licciardone J.C., Kearns C.M., Hodge L.M., Minotti D.E. Osteopathic manual treatment in patients with diabetes mellitus and comorbid chronic low back pain: subgroup results from the OSTEOPATHIC Trial. J Am Osteopath Assoc. 2013;113(6):468–478.
5. Iskra D.A. Comorbidity of type 2 diabetes mellitus and back pain. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2018;118(8):123–130 (in Russ.). Doi: 10.17116/jnevro2018118081126.
6. Molsted S., Tribler J., Snorgaard O. Musculoskeletal pain in patients with type 2 diabetes. Diabetes Research and Clinical Practice. 2012;96(2):135–140. DOI: 10.1016/j.diabres.2011.12.022.
7. Pai L.W., Hung C.T., Li S.F. et al. Musculoskeletal pain in people with and without type 2 diabetes in Taiwan: a population based, retrospective cohort study. BMC musculoskeletal disorders. 2015;16(1):364. DOI: 10.1186/s12891-015-0819-4.
8. Wang Y.X., Wang J.Q., Kaplar Z. Increased low back pain prevalence in females than in males after menopause age: evidences based on synthetic literature review. Quantitative imaging in medicine and surgery. 2016;6(2):199–206. DOI: 10.21037/qims.2016.04.06.
9. Zolotovskaia I.A., Davydkin I.L. Cognitive-cytokine effect of nonsteroidal antiinflammatory drugs in the therapy of elderly patients with osteoarthritis. Adv. geront. 2018;8(1):26–32. DOI: 10.1134/s2079057018010149.
10. Licciardone J.C., Kearns C.M., Minotti D.E. Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: Results from the OSTEOPATHIC Trial. Manual Therapy. 2013;18(6):533–540. DOI: 10.1016/j.math.2013.05.006.
11. Idowu O.A., Adeniyi A.F. Efficacy of graded activity with and without daily-monitored-walking on pain and back endurance among patients with concomitant low-back pain and type-2 diabetes: a randomized trial. Ethiop J Health Sci. 2020;30(2):233–242. DOI: 10.4314/ejhs.v30i2.11.
12. Le Roux C.W., Astrup A., Fujioka K. et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet 2017;389(10077):1399–1409. DOI: 10.1016/s0140-6736(17)30069-7.
13. Wei J., Liu X., Xue H. et al. Comparisons of visceral adiposity index, body shape index, body mass index and waist circumference and their associations with diabetes mellitus in adults. Nutrients. 2019;11(7):1580. DOI: 10.3390/nu11071580.
14. Weymann N., Dirmaier J., von Wolff A. et al. Effectiveness of a Web-based tailored interactive health communication application for patients with type 2 diabetes or chronic low back pain: randomized controlled trial. J Med Internet Res. 2015;17(3):e53. DOI: /10.2196/jmir.3904.
15. Standards of Medical Care in Diabetes — 2021. Diabetes Care. 2021;44(1):S1–S232. DOI: 10.2337/dc21-Sint.
16. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes — 2020. Diabetes Care. 2020;43(1):193–202. DOI: 10.2337/dc20-S015.
17. Older Adults: Standards of Medical Care in Diabetes — 2021. American Diabetes Association. Diabetes Care. 2021;44(1):S168–S179. DOI: 10.2337/dc21-S012.
18. Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes — 2021. American Diabetes Association. Diabetes Care. 2021;44(1):S100–S110. DOI: 10.2337/dc21-S008.
19. Parfenov V.A., Yakhno N.N., Kukushkin M.L. and others. Acute nonspecific (musculoskeletal) low back pain. Recommendations of the Russian Society for the Study of Pain (ROIB). Nevrologiya, neyropsikhiatriya, psikhosomatika. 2018;10(2):4–11 (in Russ.). DOI: 10.14412/2074-2711-2018-2-4-11.
20. Parfenov V.A., Yakhno N.N., Davydov O.S. et al. Chronic nonspecific (musculoskeletal) low back pain. Recommendations of the Russian Society for the Study of Pain (ROIB). Nevrologiya, neyropsikhiatriya, psikhosomatika. 2019;11(App. 2):7–16 (in Russ.). DOI: 10.14412 / 2074-2711-2019-2S-7-16.
21. Cooper C., Chapurlat R., Al‑Daghri N. et al. Safety of oral non‑selective non‑steroidal anti‑inflammatory drugs in osteoarthritis: what does the literature say? Drugs and Aging. 2019;36(1):S15–S24. DOI: 10.1007/s40266-019-00660-1.
22. Zonova E.V., Karateev A.E. A substantiated approach to the choice of non-steroidal anti-inflammatory drugs for osteoarthritis. Modern rheumatology. 2018;12(4):47–53 (in Russ.). DOI: 10/14412/1996-7012-2018-4-47-53.
23. Karateev A.E., Lila A.M., Pogozheva E.Yu. et al. Efficacy of meloxicam in acute back pain: evidence from an observational non-interventional multicenter study. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2018;118(6):24–30 (in Russ.). DOI: 10.17116/jnevro20181186124.
24. Zolotovskaya I.A., Davydkin I.L., Borovkova N.Yu. Renal-associated escaping effect of antihypertensive therapy in patients with arterial hypertension while taking non-steroidal anti-inflammatory drugs (results of the PANDA cohort study). Arterial’naya gipertenziya. 2017;23(6):517–528 (in Russ.). DOI: 10.18705/1607-419x-2017-23-6-517-528.
25. Prokopenko S.V., Isaeva N.V., Shanina E.G. Diagnosis and treatment of back pain in patients with comorbid pathology. RMJ. 2016;24(24):1593–1598 (in Russ.).
26. Karateev A.E., Nasonov E.L. Meloxicam in Russia: 20 years together. Terapevticheskiy arkhiv. 2016;88(12):149–158 (in Russ.). DOI: 10.17116/terarkh20168812149-158.
27. Shostak N.A., Klimenko A.A., Demidova N.A., Kondrashov A.A. The problem of cardio safety of non-steroidal anti-inflammatory drugs. Terapevticheskiy arkhiv. 2016;5:113–117 (in Russ.). DOI: 10.17116/terarkh2016885113-117.
28. Nikiforov R.V., Shevtsova V.I., Zuikova A.A. Evaluation of the prohypertensive effect of meloxicam on blood pressure indicators. Arkhiv vnutrenney meditsiny. 2019;9(1):60–63 (in Russ.). DOI: 10.20514/2226-6704-2019-9-1-60-63.
29. Poverennova I.E., Zolotovskaya I.A. Cerebrovascular risks and prediction of complications in patients with back pain while taking non-steroidal anti-inflammatory drugs. Terapevticheskiy arkhiv. 2015;5:53–57 (in Russ.).
30. Akarachkova E.S., Artemenko A.R., Belyaev A.A. et al. Difficult choice of NSAIDs for pain management in multimorbid patients. RMJ. 2020;28 (8):16–22 (in Russ.).
31. Larina V.N., Chukaeva I.I. Rational choice of non-steroidal anti-inflammatory drugs for cardiovascular risk. Meditsinskiy alfavit. 2017;34(2 6–13 (in Russ.).
32. Torshin I.Yu., Gromova O.A., Stakhovskaya L.V. et al. Differential chemoreactomic analysis of synergistic combinations of tolperisone and non-steroidal anti-inflammatory drugs. Nevrologiya, neyropsikhiatriya, psikhosomatika. 2019;11(2):78–85 (in Russ.). DOI: 10.14412 / 2074-2711-2019-2-78-85.
33. Dadasheva M.N., Razilova A.V., Gorenkov R.V., Kruglov V.A. Evaluation of the effectiveness of the effect of domestic tolperisone on hemodynamic parameters in patients with pain syndrome of various localization. Nervnyye bolezni. 2019;1:17–22 (in Russ.). DOI: 10.24411/2071-5315-2018-12080.
34. Pilipovich A.A., Danilov A.B. The role of B vitamins in the treatment of complications of diabetes mellitus. Terapiya. 2017;7(17):50–54 (in Russ.).
35. Gromova O.A., Torshin I.Yu., Putilina M.V. et al. About the mechanisms of synergistic action of tolperisone, meloxicam and B vitamins in the treatment of peripheral pain syndromes. Meditsinskiy sovet. 2020;8:54–64 (in Russ.). DOI: 10.21518/2079-701X-2020-8-54-64.
36. Shavlovskaya O.A., Romanov I.D. Evaluation of the efficacy and tolerability of complex therapy for non-specific low back pain. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2020;120(7):63–67 (in Russ.). DOI: 10.17116 / jnevro202012007163.
37. Dadasheva M.N., Gorenkov R.V., Zolotovskaya I.A., Dadasheva K.N. Evaluation of the clinical efficacy and tolerability of complex therapy in patients with acute pain in the lower back. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2020;120(9):47–52 (in Russ.). DOI: 10.17116 / jnevro20201200911.
38. Gorenkov R.V., Dadasheva M.N., Zolotovskaya I.A., Kruglov V.A. Comparative efficacy and tolerability of central muscle relaxants in elderly patients with nonspecific musculoskeletal pain. Nevrologiya, neyropsikhiatriya, psikhosomatika. 2020;12(1):39–44 (in Russ.). DOI: 10.14412/2074-2711-2020-1-39-44.
39. Chiba L., Zhusupova A.S., Likhachev S.A. et al. Systematic review of the use of muscle relaxants for lower back pain. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2018;118(12):100–113 (in Russ.). DOI: 10.17116 / jnevro2018118121100.
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