Justification of the use of non-steroidal anti-inflammatory drugs injectable forms
DOI: 10.32364/2587-6821-2020-4-8-518-524
A.E. Karateev
Research Institute of Rheumatology named after V.A. Nasonova, Moscow, Russian Federation
Treatment of acute intense pain requires the use of strong fast-acting analgesics, such as parenteral forms of non-steroidal anti-inflammatory drugs (NSAIDs). Intravenous and intramuscular (i.m.) NSAIDs administration increases the bioavailability of active substances, allows for analgesic therapy in the presence of restrictions for oral administration, and is predominant in the rate of analgesic action onset versus the latter. When choosing NSAIDs for i.m. administration, the risk of topical post-injection and systemic adverse reactions should be considered. Original meloxicam for i.m. injection is characterized by a favorable risk-benefit ratio and ease of use. In clinical studies, there was no significant increase in creatinine phosphokinase levels, reflecting damage to muscle fibers, after a series of injections of meloxicam i.m. versus other NSAIDs, such as diclofenac and piroxicam. During the search in PubMed, Medline, Google, there was no description of serious topical complications after i.m. administration of meloxicam. In recent years, several large open-label studies have been conducted in Russia demonstrating the efficacy and safety of meloxicam injectable form in acute/subacute non-specific back pain and injuries. The review provides a brief description of the main clinical studies concerning the original meloxicam for i.m. injection.
Keywords: NSAIDs, meloxicam, intramuscularly, efficacy, safety.
For citation: Karateev A.E. Justification of the use of non-steroidal anti-inflammatory drugs injectable forms. Russian Medical Inquiry. 2020;4(8):518–524. DOI: 10.32364/2587-6821-2020-4-8-518-524.
About the author:
Andrey E. Karateev — Dr. of Sci. (Med.), Head of the Laboratory of Morbid Physiology and Clinical Polymorphism of Musculoskeletal Diseases, Research Institute of Rheumatology named after V.A. Nasonova: 34A, Kashirskoe road, Moscow, 115522, Russian Federation; ORCID iD 0000-0002-1391-0711.
Contact information: Andrey E. Karateev, e-mail: aekarat@yandex.ru. Financial Disclosure: the author has not a financial or property interest in any material or method mentioned. There is no conflict of interests. Received 21.09.2020, revised 05.10.2020, accepted 20.10.2020.
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4. Michaelides A., Zis P. Depression, anxiety and acute pain: links and management challenges. Postgrad Med. 2019;131(7):438–444. DOI: 10.1080/00325481.2019.1663705.
5. Thapa P., Euasobhon P. Chronic postsurgical pain: current evidence for prevention and management. Korean J Pain. 2018;31(3):155–173. DOI: 10.3344/kjp.2018.31.3.155.
6. Pak D.J., Yong R.J., Kaye A.D., Urman R.D. Chronification of Pain: Mechanisms, Current Understanding, and Clinical Implications. Curr Pain Headache Rep. 2018;22(2):9. DOI: 10.1007/s11916-018-0666-8.
7. Babatunde O.O., Jordan J.L., Van der Windt D.A. et al. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One. 2017;12(6):e0178621. DOI: 10.1371/journal.pone.0178621.
8. Hsu J.R., Mir H., Wally M.K., Seymour R.B. Orthopaedic Trauma Association Musculoskeletal Pain Task Force. Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury. J Orthop Trauma. 2019;33(5): e158–e182. DOI: 10.1097/BOT.0000000000001430.
9. Atkinson T.J., Fudin J. Nonsteroidal Antiinflammatory Drugs for Acute and Chronic Pain. Phys Med Rehabil Clin N Am. 2020;31(2):219–231. DOI: 10.1016/j.pmr.2020.01.002.
10. Gupta A., Bah M. NSAIDs in the Treatment of Postoperative Pain. Curr Pain Headache Rep. 2016;20(11):62. DOI: 10.1007/s11916-016-0591-7.
11. Shatsky М. Evidence for the use of intramuscular injections in outpatient practice. Fam Physician. 2009;79(4):297–300.
12. Dougados M., Listrat V., Duchesne L., Amor B. Comparative efficacy of ketoprofen related to the route of administration (intramuscular or per os). A double-blind study versus placebo in rheumatoid arthritis. Rev Rhum Mal Osteoartic. 1992;59(11):769–773.
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14. Wick E.C., Grant M.C., Wu C.L. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques: A Review. JAMA Surg. 2017;152(7):691–697. DOI: 10.1001/jamasurg.2017.0898.
15. Hoy S.M. Diclofenac Sodium Bolus Injection (Dyloject (TM)): A Review in Acute Pain Management. Drugs. 2016;76(12):1213–1220. DOI: 10.1007/s40265-016-0619-7.
16. Vadivelu N., Gowda A.M., Urman R.D. et al. Ketorolac tromethamine — routes and clinical implications. Pain Pract. 2015;15(2):175–193. DOI: 10.1111/papr.12198. Epub 2014 Apr 16.
17. Martinez L., Ekman E., Nakhla N. Perioperative Opioid-sparing Strategies: Utility of Conventional NSAIDs in Adults. Clin Ther. 2019;41(12):2612–2628. DOI: 10.1016/j.clinthera.2019.10.002.
18. McNicol E.D., Ferguson M.C., Schumann R. Single-dose intravenous diclofenac for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018;8(8):CD012498. DOI: 10.1002/14651858.CD012498.pub2.
19. Sawyer G.A., Anderson B.C., Raukar N.P., Fadale P.D. Intramuscular ketorolac injections in the athlete. Sports Health. 2012;4(4):319–327. DOI: 10.1177/1941738112439686.
20. Matava M.J. Injectable Nonsteroidal Anti-Inflammatory Drugs in Sport. Clin J Sport Med. 2018;28(5):443–450. DOI: 10.1097/JSM.0000000000000602.
21. van der Gaag W., Roelofs P., Enthoven W. et al. Non-steroidal anti-inflammatory drugs for acute low back pain. Cochrane Database Syst Rev. 2020;4(4):CD013581. DOI: 10.1002/14651858.CD013581.
22. Sproviero E., Albamonte E., Costantino C. et al. Efficacy and safety of a fixed combination of intramuscular diclofenac 75 mg + thiocolchicoside 4 mg in the treatment of acute low back pain: a phase III, randomized, double blind, controlled trial. Eur J Phys Rehabil Med. 2018;54(5):654–662. DOI: 10.23736/S1973-9087.17.04923-1.
23. Zippel H., Wagenitz A. A multicentre, randomised, double-blind study comparing the efficacy and tolerability of intramuscular dexketoprofen versus diclofenac in the symptomatic treatment of acute low back pain. Clin Drug Investig. 2007;27(8):533–543. DOI: 10.2165/00044011-200727080-00002.
24. Babej-Dölle R., Freytag S., Eckmeyer J. et al. Parenteral dipyrone versus diclofenac and placebo in patients with acute lumbago or sciatic pain: randomized observer-blind multicenter study. Int J Clin Pharmacol Ther. 1994;32(4):204–209.
25. Rotman-Pikielny P., Levy Y., Eyal A., Shoenfeld Y. Pyomyositis or "injectiositis" — Staphylococcus aureus multiple abscesses following intramuscular injections. Isr Med Assoc J. 2003;5(4):295–296.
26. Quincer E., Jaggi P. Nicolau Syndrome: A Rare Complication following Intramuscular Injection. J Pediatr. 2019;212:238–238.e2. DOI: 10.1016/j.jpeds.2019.04.004. Epub 2019 May 3.
27. Geyik S., Geyik M., Yigiter R. et al. Preventing Sciatic Nerve Injury due to Intramuscular Injection: Ten-Year Single-Center Experience and Literature Review. Turk Neurosurg. 2017;27(4):636–640. DOI: 10.5137/1019-5149.JTN.16956-16.1.
28. Rygnestad T., Kvam A.M. Streptococcal myositis and tissue necrosis with intramuscular administration of diclofenac (Voltaren). Acta Anaesthesiol Scand. 1995;39(8):1128–1130. DOI: 10.1111/j.1399-6576.1995.tb04243.x.
29. Kortelainen M.L., Särkioja T. Fatal complications of intramuscular and intra-articular injections. Z Rechtsmed. 1990;103(7):547–554. DOI: 10.1007/BF01254408.
30. Ahrens N., Schewior L., Garbe E. et al. Massive haemolysis after intramuscular diclofenac in a patient who apparently tolerated oral medication. Vox Sang. 2004;86(1):71–74. DOI: 10.1111/j.0042-9007.2004.00389.x.
31. Tarloff D., Lamacraft G., Joubert G. The prevalence of skin scars in patients previously given intramuscular diclofenac injections attending the Pain Clinic at Universitas Academic Hospital, Bloemfontein, South Africa. S Afr Med J. 2017;107(2):101–105. DOI: 10.7196/SAMJ.2017.v107i2.12012.
32. Lardelli P.F., Jermini L.M.M., Milani G.P. et al. Nicolau syndrome caused by non-steroidal anti-inflammatory drugs: Systematic literature review. Int J Clin Pract. 2020;74(10): e13567. DOI: 10.1111/ijcp.13567.
33. Strom B.L., Berlin J.A., Kinman J.L. et al. Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study. JAMA. 1996;275(5):376–382.
34. Chang C.H., Chen H.C., Lin J.W. et al. Risk of hospitalization for upper gastrointestinal adverse events associated with nonsteroidal anti-inflammatory drugs: a nationwide case-crossover study in Taiwan. Pharmacoepidemiol Drug Saf. 2011;20(7):763–771. DOI: 10.1002/pds.2140.
35. Shau W.-Y., Chen H.-C., Chen S.-T. et al. Risk of new acute myocardial infarction hospitalization associated with use of oral and parenteral non-steroidal anti-inflammation drugs (NSAIDs): a case-crossover study of Taiwan’s National Health Insurance claims database and review of current evidence. BMC Cardiovasc Disord. 2012;12:4. DOI: 10.1186/1471-2261-12-4.
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