ABSTRACT

INTRODUCTION. The choice of optimal therapy for chronic lower back pain includes: influence on all links of the pain vicious circle, has analgesic and anti-inflammatory effects, chondroprotective effect.

AIM. A retrospective comparative analysis of outpatient records of patients with chronic lower back pain with a course of therapy with drugs containing chondroitin sulfate – Chondroguard, and bioactive concentrate of small marine fish – Alflutop.

MATERIAL AND METHODS. Outpatient records of patients who took Chondroguard and Alflutop in the period from January 2022 to April 2024 were included. Data from 60 patients (medium age 51.5±9.7 years). Patients were retrospectively divided into two groups depending on the strategy of pain management. The main group (n=30; medium age 51.0±9.8 years), who received Chondroguard intramuscularly (I/ m) every other day No. 25 according to the scheme: the first 3 injections (1st, 3rd, 5th day) - 1 ml (100 mg), with good tolerability from the 4th injection (7 day) – 2 ml (200 mg); and the Comparison group (n=30; medium age 49.3±9.9 years), received Alflutop 2 ml, 1 time a day, every other day, a short course of 10 days. The dynamics of the condition was assessed on days 10, 20, 50.

RESULTS AND DISCUSSION. By day 50 in the Main group, there was a decrease in pain by an average of 86.6% according to the numerical rating scale and an improvement in the functional status according to the Oswestry scale of 95.5%, in the comparison group there was a decrease in pain by an average of 77.2%, an improvement in the functional status according to Oswestry scale of 86.7%. By day 50, the severity of pain syndrome in the Main group decreased by 91.2%, in the Comparison group – by 33.9%; indicators of the functional status of Oswestry scale in the Main group improved by 97.3%, in the Comparison group – by 84.8%. In the Main group, the need for multiple nonsteroidal anti-inflammatory drugs on the 10th day of therapy decreased to 1 tablet per day in 76.7%, in the Comparison group – in 16.7%. In the main group, after a course of therapy for 21.3±2.2 months. they did not consult a doctor in the comparison group after 5.3±1.1 months. A second course of therapy was conducted.

CONCLUSION. In the Main group, the effects of therapy can be regarded as long-term, since the effects of highly purified chondroitin sulfate on the pathogenetic mechanisms of the formation of chronic lower back pain remain.

KEYWORDS: pain syndrome, lower back pain, chondroitin sulfate, Chondroguard

For citation: Shavlovskaya O.A., Romanov I.D., Bokova I.A. Retrospective Comparative Analysis of Chondroprotective Therapy Effectiveness in Chronic Lower Back Pain Patients. Comorbidity Neurology. 2024; 1 (3): 45-53. https://doi.org/10.62505/3034-185x-2024-1-3-45-53

*For correspondence: Olga A. Shavlovskaya, Dr. Sci. (Med.), Professor, Chair of Organization of Medical Rehabilitation and Sanatorium Treatment, International University of Restorative Medicine, Moscow, Russia, e-mail: shavlovskaya@1msmu.ru.

REFERENCES

1.Urits I., Burshtein A., Sharma M., et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr. Pain Headache Rep. 2019; 23 (3): 23. https://doi.org/10.1007/s11916-019-0757-1

2.Kern K.U. Low back pain management in routine clinical practice: what is important for the individual patient? Pain Manag. 2023; 13 (4): 243-252. https://doi.org/10.2217/pmt-2022-0096

3.Farra F.D., Risio R.G., Vismara L., Bergna A. Effectiveness of osteopathic interventions in chronic non-specific low back pain: a systematic review and meta-analysis. Complement. Ther. Med. 2021; 56: 102616. https://doi.org/10.1016/j.ctim.2020.102616

4.Naumov A.V., Khovasova N.O., Moroz V.I., Tkacheva O.N., Shavlovskaya O.A. The clinical status and treatment options for osteoarthritis in patients with frailty. Therapeutic Archive. 2019; 91 (12): 42-48. (In Russ.)

5.Murphy L., Schwartz T.A., Helmick CG., et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008; 59 (9): 1207-1213. https://doi.org/10.1002/art.24021

6.Nijs J., Kosek E., Chiarotto A., et al. Nociceptive, neuropathic, or nociplastic low back pain? The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations. Lancet Rheumatol. 2024; 6 (3): e178-e188. https://doi.org/10.1016/S2665-9913(23)00324-7

7.Shavlovskaya O.A., Romanov I.D., Prokofyeva Yu.S. Experience with chondroitin sulfate in the combination therapy of lower back pain. Neurology, Neuropsychiatry, Psychosomatics. 2020; 12 (3): 75-81. https://doi.org/10.14412/2074-2711-2020-3-75-81 (In Russ.)

8.Istomina E.V., Shikhkerimov R.K. The possibilities of using chondroitin sulfate in patients with chronic back pain. S.S. Korsakov Journal of Neurology and Psychiatry. 2019; 119 (3): 12-15. https://doi.org/10.17116/jnevro201911903112 (In Russ.)

9.Kamchatnov PR, Chugunov AV, Khanmurzaeva SB. New possibilities of treatment of low back pain. S.S. Korsakov Journal of Neurology and Psychiatry. 2017; 117 (12): 162-167. https://doi.org/10.17116/jnevro2017117121162-167 (In Russ.)

10.Golovacheva V.A., Golovacheva A.A., Parfenov V.A. Management of patients with subacute back pain: how to effectively prevent chronicity. Neurology, Neuropsychiatry, Psychosomatics. 2022; 14 (4): 62-67. https://doi.org/10.14412/2074-2711-2022-4-62-67 (In Russ.)

11.Geenen R., Overman C.L., Christensen R., et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018; 77 (6): 797-807. https://doi.org/10.1136/annrheumdis-2017-212662

12.Bruyere O., Honvo G., Veronese N., et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019; 49 (3): 337-350. https://doi.org/10.1016/j.semarthrit.2019.04.008

13.Shavlovskaya OA, Gromova О.А., Torshin I.Yu., Romanov I.D. From misconceptions to reasonable osteoarthritis patients therapy. Farmakoekonomika. Modern Pharmacoeconomics and Pharmacoepidemiology. 2023; 16 (2): 317-330. https://doi.org/10.17749/2070-4909/farmakoekonomika.2023.183 (In Russ.)

14.Анатомо-терапевтическая химическая (АТХ) система классификации с установленными суточными дозами. Всемирная Организация Здравоохранения. Доступно по: https://atcddd.fhi.no/atc_ddd_index/ (дата обращения: 23.05.2024) 

15.Shavlovskaya O.A. SYSADOA place in degenerative-dystrophic joints diseases treatment of neurological practice from the standpoint of evidence-based medicine. S.S. Korsakov Journal of Neurology and Psychiatry. 2022; 122 (3): 30-37. https://doi.org/10.17116/jnevro202212203130 (In Russ.)

16.Sarvilina I.V., Galustyan A.N., Hadzhidis A.K., et al. Comparative clinical and economic analysis of using SYSADOA drugs containing chondroitin sulphate or influencing its biosynthesis in the treatment of patients with stage II knee osteoarthritis. Modern Pharmacoeconomics and Pharmacoepidemiology. 2019; 12 (4): 255-266. https://doi.org/10.17749/2070-4909.2019.12.4.255-266 (In Russ.)

17.Zolotovskaya I.A., Davydkin I.L. A antiresorptivecytokine effects of chondroprotective therapy in patients with lower back pain. S.S. Korsakov Journal of Neurology and Psychiatry. 2020; 120 (4): 65-71. https://doi.org/ 10.17116/jnevro202012004165 (In Russ.)

18.Lila A.M., Karateev A.E., Alexeeva L.I., et al. Alflutop Russian longitudinal multicenter observational study: use in patients with chronic back pain (message 3). Modern Rheumatology Journal. 2024; 18 (1): 70-75. https://doi.org/10.14412/1996-7012-2024-1-70-75 (In Russ.)

19.Samartsev I.N., Zhivolupov S.A., Barantsevich E.R., Danilov A.B. The evaluation of the efficacy of Alflutop in the complex treatment of patients with chronic lower back pain (the observational study ZEITNOT). S.S. Korsakov Journal of Neurology and Psychiatry. 2021; 121 (2): 24-30. https://doi.org/10.17116/jnevro202112102124 (In Russ.)

20.Zhivolupov SA, Samartsev IN, Ponomarev VV. Quantative evaluation and analysis of the central mechanisms involved in analgesic effect of Alflutop in patients with chronic lower back pain. S.S. Korsakov Journal of Neurology and Psychiatry. 2021; 121 (10): 38–44. https://doi.org/10.17116/jnevro202112110138 (In Russ.)

21.Lukina G.V., Sigidin Ya.A., Chichasova N.V. Alflutop in the treatment of osteoarthritis. Rheumatology Science and Practice. 2004; (3): 52-54. https://doi.org/10.14412/1995-4484-2004-1481 (In Russ.)

22.Ton J., Perry D., Thomas B., et al. PEER umbrella systematic review of systematic reviews: Management of osteoarthritis in primary care. Can Fam Physician. 2020; 66 (3): e89-e98

ADDITIONAL INFORMATION

Olga A. Shavlovskaya, Dr. Sci. (Med.), Professor, Chair of Organization of Medical Rehabilitation and Sanatorium Treatment, University of Restorative Medicine, Moscow, Russia. E-mail: shavlovskaya@1msmu.ru. ORCID: https://orcid.org/0000-0003-3726-0730

Igor D. Romanov, Neurologist, Head of Scientific and Advisory Neurological Care, «MD-Clinic» medical centers; Chief specialist of the Department of Methodological Support of additional professional education programs, International University of Restorative Medicine, Moscow, Russia. ORCID: https://orcid.org/0009-0003-0874-2834

Irina A. Bokova, Cand. Sci. (Med.), Associate Professor, Chair of Restorative Medicine, Rehabilitation and Balneology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia. ORCID: https://orcid.org/0000-0002-1640-1605

Author contributions. All authors confirm their authorship according to the ICMJE criteria (all authors contributed significantly to the conception, study design and preparation of the article, read and approved the final version before publication). Shavlovskaya O.A. – concept and design, collection and processing of data from literature sources, statistical analysis of data from literature sources, text writing; Romanov I.D., Bokova I.A. – editing.

Funding. This study was  supported by any external sources of funding.

Disclosure. The authors declare no apparent or potential conflicts of interest related to the publication of this article.

The content is available under the Creative Commons Attribution 4.0 License.

©2024. Olga A. Shavlovskaya, Ivan D. Romanov, Irina A. Bokova