mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2017-3-112-120mrj-784Research ArticleОБЗОРЫREVIEWSФармакотерапия хронической боли в спине: есть ли перспективы?Pharmacotherapy of chronic back pain: Are there prospects?ШварцманГ. И.ShvartsmanG. I.

191015, Санкт-Петербург, ул. Кирочная, 41

41, Kirochnaya St., Saint Petersburg 191015

КаратеевА. Е.KarateevA. E.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115552

aekarat@yandex.ruФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииРоссияI.I. Mechnikov North-West State Medical University, Ministry of Health of RussiaRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation201726092017113112120Copyright © Шварцман Г.И., Каратеев А.Е., 20172017Шварцман Г.И., Каратеев А.Е.Shvartsman G.I., Karateev A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/784

Лечение хронической боли в спине (ХБС) – сложная терапевтическая задача. Гетерогенность патологии, различные фенотипы боли, наличие коморбидных заболеваний и индивидуальная чувствительность к лекарственным препаратам требуют использования широкого спектра обезболивающих средств с разным механизмом действия. В настоящем обзоре кратко рассмотрена доказательная база основных фармакологических групп, которые применяются для лечения ХБС в реальной клинической практике или проходят клинические испытания: нестероидные противовоспалительные препараты (НПВП), глюкокортикоиды, ингибиторы фактора некроза опухоли (ФНО) α, ингибиторы фактора роста нервов, опиоиды, антидепрессанты и миорелаксанты, а также антибиотикотерапия. Показано, что в настоящее время даже в перспективе не существует лекарств, применение которых способно полностью решить проблему ХБС. Лечение целесообразно начинать с НПВП. Хотя их эффективность при ХБС относительно невысока, тем не менее использование НПВП позволяет добиться определенного уменьшения боли и создать условия для успешного применения других классов препаратов и немедикаментозных методов. Рассмотрены достоинства нимесулида, который может считаться препаратом первой линии среди НПВП по соотношению эффективности, относительной безопасности и доступности.

Treatment for chronic back pain (CBP) is a complex therapeutic challenge. The heterogeneity of the disease, different phenotypes of pain, comorbidities, and individual sensitivity to drugs require the use of a broad-spectrum of analgesics with different mechanisms of action. The present review briefly considers the evidence base of basic pharmacological groups that are used for the treatment of CBP in real clinical practice or in clinical trials: nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, tumor necrosis factor-α (TNF-α) inhibitors, nerve growth factor inhibitors, opioids, antidepressants, and muscle relaxants, as well as antibiotic therapy. It is shown that at the moment there are no existing or promising drugs that are able to completely solve the problem of CBP. Treatment should be initiated with NSAIDs. Although their efficacy in CBP is relatively low; nevertheless, the use of NSAIDs makes it possible to achieve a certain reduction in pain and to create conditions for the successful use of other drug classes and non-drug methods. The benefits of nimesulide that may be deemed to be a first-line drug among NSAIDs are considered in terms of its efficacy, relative safety, and availability.

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The authors declare that there are no conflicts of interest present.