Efficacy and safety of nicoboxil/nonivamide ointment for the treatment of acute pain in the low back - A randomized, controlled trial

Background

Until now, nonivamide/nicoboxil ointment has not been tested in a randomized trial for the treatment of acute non‐specific low back pain.

Methods

This phase III randomized, double‐blind, active‐ and placebo‐controlled, multi‐centre trial investigated efficacy, safety and tolerability of topical nicoboxil 2.5%/nonivamide 0.4% for treatment of acute non‐specific low back pain [primary endpoint: pain intensity (PI) difference between pre‐dose baseline and 8 h after the first application].

Results

Patients (n = 805), 18–74 years of age were treated for up to 4 days with nicoboxil 2.5%/nonivamide 0.4%, nicoboxil 2.5%, nonivamide 0.4% or placebo ointment. Pre‐dose baseline pain intensity (6.6 on a 0‐ to 10‐point numerical rating scale) was reduced by 1.049 points with placebo, by 1.428 points with nicoboxil, by 2.252 points with nonivamide and by 2.410 points with nicoboxil/nonivamide after 8 h (p < 0.0001 for nicoboxil/nonivamide vs. placebo, nicoboxil; p = 0.4171 for nicoboxil/nonivamide vs. nonivamide). At the end of treatment, the combination provided more pronounced PI reduction (3.540 points) compared with nicoboxil (2.371, p < 0.0001), nonivamide (3.074, p = 0.0259) and placebo (1.884, p < 0.0001). Low back mobility scores on Day 1 were better for the combination compared with all other treatments (p < 0.044); on Day 2–4, scores were better than for placebo and nicoboxil (p < 0.003). Patients assessed efficacy of the combination as greater than of the comparators (p ≤ 0.0129). All treatments were tolerated well. No treatment‐related serious adverse events were reported.

Conclusion

Nicoboxil/nonivamide ointment is an effective, well‐tolerated medication for the treatment of acute non‐specific low back pain.

Endurance training alters skeletal muscle MCT contents in T2DM men

Patients suffering from type 2 diabetes mellitus (T2DM) often exhibit chronic elevated lactate levels which can promote peripheral insulin resistance by disturbing skeletal muscle insulin-signaling. Monocarboxylate transporter (MCT) proteins transfer lactate molecules through cellular membranes. MCT-1 and MCT-4 are the main protein isoforms expressed in human skeletal muscle, with MCT-1 showing a higher affinity (lower Km) for lactate than MCT-4. T2DM patients have reduced membranous MCT-1 proteins. Consequently, the lactate transport between muscle cells and the circulation as well as within an intracellular lactate shuttle, involving mitochondria (where lactate can be further metabolized), can be negatively affected. This study investigates whether moderate cycling endurance training (3 times per week for 3 months) can change skele-tal muscle MCT contents in T2DM men (n=8, years=56±9, body mass index (BMI)=32±4 kg/m(2)). Protein content analyses (immuno-histochemical stainings) were performed in bio-psies taken from the vastus lateralis muscle. Intracellular MCT-1 proteins were up-regulated (relative increase+89%), while intracellular MCT-4 contents were down-regulated (relative decrease - 41%) following endurance training. Sarcolemmal MCT-1 and MCT-4 did not change. The question of whether the training-induced up-regulation of intracellular MCT-1 leads to an improved lactate transport (and clearance) in T2DM patients requires further research.

Training alters the skeletal muscle antioxidative capacity in non-insulin-dependent type 2 diabetic men

The present study analyzes the oxidative stress situation in the skeletal muscle of overweight/obese men suffering from non-insulin-dependent type 2 diabetes mellitus [T2DM, n=16, years=61±7, body mass index (BMI)=31±4 kg/m(2) ] and BMI-matched non-diabetic male control subjects (CON, n=7, years=53±6, BMI=30±4 kg/m(2) ). Furthermore, it investigates whether physical training can alter the skeletal muscle antioxidative capacity of T2DM patients at rest. Molecule content analyses (immunohistochemical stainings) of 8-iso-prostaglandin-F2α (8-Iso-PGF), superoxide dismutase-2 (SOD2), glutathione peroxidase-1 (GPX1), peroxiredoxin isoforms (PRDX 1-6) and heat-shock-protein-70 (HSP70) were performed in biopsies taken from the vastus lateralis muscle. Under basal conditions, 8-Iso-PGF was significantly decreased in T2DM patients (-35.7%), whereas PRDX2 and PRDX6 were significantly increased relative to CON (+82.6%; +82.3%). Differences were neither observed in SOD2 nor in GPX1 or PRDX1, 3, 4, 5 density. Regular physical activity (moderate endurance or resistance training twice a week for 3 months) did not alter PRDX1, 2, 3, 4, 6 in the skeletal muscle of T2DM patients, but significantly increased SOD2 (+65.9%), GPX1 (+62.4%), PRDX5 (+37.5%), and HSP70 (+48.5%). Overweight/obese men with non-insulin-dependent T2DM exhibit up-regulated cytosolic peroxiredoxin contents relative to BMI-matched controls. Regular training further up-regulates cytosolic and mitochondrial antioxidative enzymes in T2DM patients and improves their cellular protection systems. This may contribute to a retardation of the disease's progression.

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We use projected Delaunay tetrahedra and a maximum independent set approach to compute large subsets of convex quadrangulations on a given set of points in the plane. The new method improves over the popular pairing method based on triangulating the point set.

MSTN mRNA after varying exercise modalities in humans

The aim of this study was to examine the effects of strength and endurance training on myostatin mRNA in the vastus lateralis muscle of healthy and physically active humans. 21 healthy and physically active sports students (static and dynamic knee extensor strength 33 ± 4.5 N/kgBW; 1 185 ± 170 W, respectively; maximum oxygen uptake 52.5 ± 8 ml/kgBW/min) were recruited and randomly assigned to a moderate endurance training group (n=7), a strength training group (n=7) and a control group (n=7). Muscle biopsies were taken from the vastus lateralis muscle 3-5 days before the start as well as at the end of the 12 weeks' training period. Exercise-specific functional improvements after moderate endurance training and strength training were measured for submaximal endurance and for static and dynamic strength of the knee extensor muscles. None of the myostatin mRNA values showed significant pre-post differences or group-specific differences. These results are in contrast to data with sedentary subjects, suggesting that myostatin is necessary for adaptations of skeletal muscle to exercise stress. We conclude that functional improvements after moderate endurance training and strength training can occur without alterations in myostatin mRNA in physically active humans.

Cardio-respiratory and metabolic responses to different levels of compression during submaximal exercise

OBJECTIVE

The effects of knee-high socks that applied different levels of compression (0, 10, 20, 30 and 40 mmHg) on various cardio-respiratory and metabolic parameters during submaximal running were analysed.

METHODS

Fifteen well-trained, male endurance athletes (age: 22.2 ± 1.3 years; peak oxygen uptake: 57.2 ± 4.0 mL/minute/kg) performed a ramp test to determine peak oxygen uptake. Thereafter, all athletes carried out five periods of submaximal running (at approximately 70% of peak oxygen uptake) with and without compression socks that applied the different levels of pressure. Cardiac output and index, stroke volume, arterio-venous difference in oxygen saturation, oxygen uptake, arterial oxygen saturation, heart rate and blood lactate were monitored before and during all of these tests.

RESULTS

Cardiac output (P = 0.29) and index (P = 0.27), stroke volume (P = 0.50), arterio-venous difference in oxygen saturation (P = 0.11), oxygen uptake (P = 1.00), arterial oxygen saturation (P = 1.00), heart rate (P = 1.00) and arterial lactate concentration (P = 1.00) were unaffected by compression (effect sizes = 0.00-0.65).

CONCLUSION

This first evaluation of the potential effects of increasing levels of compression on cardio-respiratory and metabolic parameters during submaximal exercise revealed no effects whatsoever.

Effects of strength and endurance training on brain-derived neurotrophic factor and insulin-like growth factor 1 in humans

Blood neurotrophins like insulin-like growth factor (IGF-1) and brain-derived neurotrophic factor (BDNF) are discussed to mediate health benefits of physical activity in humans. The aim of the study was to analyze the training effects of moderate endurance training (Em) and strength training with high loads (Sh) on blood plasma concentrations of IGF-1 and BDNF in humans. Venous blood samples were obtained from 27 healthy students, randomly assigned to an Em, Sh, and a control group, before and after a 12-week training intervention. Sh resulted in an increase in isometric (14.5%) and dynamic (8.3%) strength of the knee extensor muscles in the Sh group and Em led to a significant increase in the endurance performance in the Em group (p<0.05). IGF-1 basal plasma concentrations decreased (p<0.05) after the intervention in all groups. There were no significant changes for BDNF. Despite specific functional adaptations induced by Em and Sh there are no correspondingly different adaptations in the basal blood concentrations of the neurotrophins IGF-1 and BDNF. Additionally, exercise per se does not result in changes in basal plasma concentrations of BDNF, suggesting that the mode of the exercise programme is a decisive factor.

Blood oxygen partial pressure affects plasma prolactin concentration in humans

Responses of plasma prolactin (PRL) concentration to acute and repeated changes in blood oxygen partial pressure (PO2a) at rest were investigated in two studies (A; B), with special reference to possible effects mediated via serotonin (5-HT) synthesis. In A, nine male subjects inhaled for 105 min gas containing different oxygen fractions for 6 days. Gas concentrations consisted of 14% (A14), 21 % (A21), 40% (A40), 60% (A60) and 80% (A80) O2 mixed with N2 as well as 100% O2 (A100). Venous and capillary blood samples were drawn before and every 15 min during gas inhalation for analysis of plasma PRL and PO2a. In B, two groups of subjects (B I; B II) were exposed to 30 min day(-1) of gas inhalation over 14 consecutive days. Gas concentration consisted for B I of 14% O2/86% N2 and for B II of 100% O2. During pre- and post-examination a baseline blood sample was drawn, followed by a neuroendocrine test of serotonergic function using a partial 5-HT1A receptor agonist (60 mg of buspirone hydrochloride). In A, each increase of inhaled oxygen fraction also resulted in higher blood POb2a. In A14, A21 and A40, plasma PRL concentrations did not change from basal level. Increases in plasma PRL concentration were found in A60 after 30 min as well as in A80 and A100 after 15 min. A higher blood PO2a induced a higher plasma PRL secretion but also an earlier decline from peak plasma PRL value despite continued inhalation of the respective oxygen concentration. During post-examination in B, basal plasma PRL concentrations were increased in B I and decreased in B II. Plasma PRL response to stimulation challenge was not affected by treatments. Thus, chronic adaptations of basal plasma PRL concentrations to decreased/increased blood PO2a were not related to up/down-regulation, respectively, of central serotonergic receptor function.