[Chondroprotectors: A range of application in general somatic practice]

A new look at back pain treatment in light of the latest ESCEO guidelines

Chronic pain (CP) is still one of the urgent problems of modern medicine. The paper provides a review of the main pharmacotherapeutic approaches from the standpoint of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) guidelines. When preparing this material, the authors have analyzed the publications available in the resources: PubMed, EMBASE, Cochrane, and еLIBRARY. The paper presents the main pathogenetic mechanisms of pain syndrome development in osteoarthritis (OA), including synovial inflammation and associated immune disorders. It considers the types of development of pain syndrome and the main prognostic outcomes according the mechanism of pain, providing a rationale for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or chondroprotectors (CPs). In accordance with the ESCEO guidelines, it is noted that when starting OA therapy, CPs should be considered as the first step (in their long-term prescription and pharmaceutical quality), then NSAIDs should be added (topically), then (if ineffective) orally, by excluding patients with hip OA. It is known that the intramuscular administration of CPs (chondroitin sulfate (CS) in particular) can increase their bioavailability. The use of glucosamine sulfate (GS) is recommended for patients over 60 years of age. According to the recommendations of the 2019 ESCEO experts, CS and GS should be used as a disease-modifying OA drug from the first step and at all subsequent stages.

[Experience of using the chondroprotector Sustagard Artro (sashe) in the treatment of lower back pain]

AIM

To compare the efficacy of oral administration of the chondroprotector (CP) Sustagard Artro and nonsteroidal anti-inflammatory drugs (NSAIDs) in reducing lower back pain and to assess the level of blood glucose in patients taking CP.

MATERIAL AND METHODS

Sixty patients with spondylarthrosis (SA) were studied. Patients were randomized into the CP group (n=30), which received Sustagard Artro (1 sachet once a day for 6 weeks), and the NSAIDs group (n=30) treated with injectable forms of different groups of NSAIDs for 3-7 days. Pain intensity was evaluated by the numerical rating scale (NRS) and the Oswestry disability index (ODI).

RESULTS

The reduction in the severity of pain on NRS was similar in both groups: 5.73±1.74 before treatment and 1.43±0.33 after treatment in the CP group; 6.03±0.93 and 1.17±0.97 in the NSAIDs group, respectively. No significant difference in the efficacy was observed between two groups on ODI: 34.66% at baseline and 1.86% after 6 weeks in the CP group; 37.47% and 2.27% in the NSAIDs group, respectively. Changes in the level of glucose were within the upper limit of normal in the CP group.

CONCLUSION

Oral administration of CP (Sustagard Artro, sashe) reduces pain syndrome as effectively as NSAIDs.