Karateev A E, Alekseeva L I, Tsurgan A V, Gontarenko N V
V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow, Russia.
Ter Arkh. 2017;89(12. Vyp. 2):175-184. doi: 10.17116/terarkh20178912175-184.
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.
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.
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).
The comprehensive pathogenetic approach used in analgesic therapy provides an effective and relatively safe relief of MSP in most patients with NBP and osteoarthritis.
应用基于俄罗斯专家建议制定的个体化发病机制方法（一种算法），评估急性/亚急性肌肉骨骼疼痛（MSP）的治疗效果。
共有262名治疗风湿性疾病患者的医生参与了ATUSA（使用系统算法进行镇痛治疗）项目。该研究纳入了3304例患有骨关节炎、非特异性背痛（NBP）和关节周围软组织风湿性疾病且经历过MSP的患者（女性占54.3%，男性占45.7%；平均年龄48.6±14.3岁）。治疗按照以下算法进行：首次开具的药物为非甾体抗炎药（NSAIDs）（醋氯芬酸）：对乙酰氨基酚和/或曲马多，禁忌时使用外用NSAIDs，有指征时使用肌肉松弛剂。在第7、14和28天评估治疗结果。每次就诊时调整治疗方案；必要时更换NSAIDs；局部注射皮质类固醇；使用抗抑郁药或抗惊厥药。研究人员使用0至10的疼痛强度数字评分量表（NRS）评估疼痛的动态变化、MSP完全缓解患者的数量以及对治疗的满意度。
97.5%的患者首次开具的药物为口服NSAIDs，67.6%的患者为口服NSAIDs联合肌肉松弛剂。到第4次就诊时，MSP的NRS评分从6.9±1.5降至2.2±1.3。28天后，仅16.2%的患者仍需要镇痛药。88.4%的患者对治疗结果的评价为良好或优秀。8.1%的病例需要更换NSAIDs；1.9%的患者需要局部注射糖皮质激素；1.5%的患者需要使用抗抑郁药或抗惊厥药，0.25%的患者需要住院治疗。2.2%的患者观察到不良事件。治疗效果（28天后疼痛完全缓解）受以下因素影响：NRS诊断（比值比[OR]，2.24；95%置信区间[CI]，1.67至3.11）、年龄≥65岁（OR，0.72；95%CI，0.52至0.98）、研究开始时中度疼痛（NRS评分≤7）（OR，2.63；95%CI，1.99至3.48）、治疗7天后轻度/中度疼痛（NRS评分<4）（OR，2.
