ABSTRACT
AIM: To evaluate the efficiency of therapy for acute/subacute musculoskeletal pain (MSP) by applying an individualized pathogenetic approach (an algorithm) elaborated on the basis of Russian experts' recommendations. SUBJECTS AND METHODS: A total of 262 physicians treating patients with rheumatic diseases participated in the ATUSA (Analgesic Treatment Using a Systemic Algorithm) program. The study enrolled 3,304 patients (54.3% women, 45.7% men; mean age, 48.6±14.3 years) with osteoarthritis, nonspecific back pain (NBP), and rheumatic diseases of periarticular soft tissues, who had experienced MSP. Treatment was performed in accordance with the following algorithm: the first prescribed medication was nonsteroidal anti-inflammatory drugs (NSAIDs) (aceclofenac): paracetamol and/or tramadol and a topical NSAID in case of contraindications and muscle relaxants in case of indications. The results of treatment were assessed after 7, 14, and 28 days. The treatment was corrected during each visit; the NSAID was, if necessary, changed; corticosteroids were locally injected; antidepressants or anticonvulsant drugs were used. The investigators assessed dynamic changes in pain using a 0-10 paint intensity numeric rating scale (NRS), the number of patients, in whom MSP was completely relieved, and satisfaction with treatment. RESULTS: The first prescribed medication was oral NSAIDs in 97.5% of the patients and those in combination with a muscle relaxant in 67.6%. By visit 4, MSP decreased from 6.9±1.5 to 2.2±1.3 NRS scores. After 28 days, only 16.2% of patients continued to need analgesics. 88.4% of the patients rated treatment results as good or excellent. NSAID switching was required in 8.1% of cases; local glucocorticosteroid injections were needed in 1.9%; there was a need for the use of an antidepressant or anticonvulsant in 1.5% and for hospitalization in 0.25%. Adverse events were observed in 2.2% of patients. The efficiency of treatment (complete pain relief after 28 days) was influenced by the following factors: NRS diagnosis (OR, 2.24; 95% CI, 1.67 to 3.11), age ≥65 years (OR, 0.72; 95% CI, 0.52 to 0.98), moderate pain (NRS scores of ≤7) at the beginning of the study (OR, 2.63; 95% CI, 1.99 to 3.48), mild/moderate pain (NRS scores of <4) after 7 days of therapy (OR, 2.5; 95% CI, 1.89 to 3.33), and the use of muscle relaxants (OR, 1.77; 95% CI, 1.23 to 2.96) (p<0.05 for all comparisons). CONCLUSION: The comprehensive pathogenetic approach used in analgesic therapy provides an effective and relatively safe relief of MSP in most patients with NBP and osteoarthritis.
