Analgesic treatment, by using a systemic algorithm

Abstract

To control musculoskeletal pain (MSP) is an important component of combination treatment for systemic inflammatory rheumatic diseases, such as rheumatoid arthritis and spondyloarthritis, and a major area of therapy for osteoarthritis and nonspecific back pain. Pain development is associated with a number of pathogenetic mechanisms: local involvement; involvement of the elements of the ligamentous apparatus; chronic muscle tension; biomechanical disorders; dysfunction of the nociceptive system. This necessitates a comprehensive approach during analgesic therapy, with combined use of drugs having a different mechanism of analgesic action. This review considers the targets of pharmacotherapy for MSP and the main groups of medications that may affect them. The paper proposes an analgesic treatment algorithm based on the diagnosis of individual elements of the pathogenesis of chronic MSP and on the successive assessment of treatment results.

Keywords

• musculoskeletal pain
• osteoarthritis
• nonspecific lower back pain
• rheumatic disease of juxta-articular soft tissues
• central sensitization
• analgesic therapy
• nonsteroidal anti-inflammatory drugs
• paracetamol
• tramadol
• muscle relaxants