OP0324 Management of musculoskeletal pain using an algorithm for selection of analgesics
Authors: A Karateev, A Tsurgan, N Gontarenko
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Musculoskeletal pain is the most common manifestation of osteoarthritis (OA) and non-specific back pain (BP). Treatment of pain includes medications with a different mechanism of action such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, muscle relaxants, antidepressants or local glucocorticoid (GC) injections. However, a uniform approach to sequential and complex therapy with these medications is not so far available. <h3>Objectives</h3> The study aims at evaluating the efficacy of combined therapy of musculoskeletal pain in real clinical practice. <h3>Methods</h3> In the open-label study were included 3304 patients (54.3% women and 45.7% men with average age of 48.9±14.6 years) with acute/subacute pain due to OA or BP. The exclusion criteria were the presence of severe co-morbidities and BP in association with neurological disorders. Treatment was carried out in accordance with the following algorithm: for a moderate/severe pain (&gt;4 scores according to an 11-point numeric rating scale, NRS) use of NSAID (aceclofenac), when NSAIDs are contraindicated – tramadol with/without paracetamol, in case of mild pain – topical NSAID with/without paracetamol, and muscle relaxants as indicated. Control of treatment efficacy was carried out on day 7 (a total of 4 visits). Change of therapy could be done at each visit and include switching to the other NSAID if the prescribed drug proved to be ineffective or intolerant, local glucocorticoid (GC) injection, addition of tramadol with/without paracetamol or administration of antidepressants or anticonvulsants. The results of treatment were assessed based on the dynamics of pain using NRS, a number of patients in whom pain was relieved completely and treatment satisfaction (a 0 to 5 rating scale where 0 is the absence of the effect or pain aggravation and 5 is an excellent effect). <h3>Results</h3> The first prescribed medication in 97.5% of patients was oral NSAID (aceclofenac 200 mg per day) and in 67.6% of patients it was aceclofenac in combination with muscle relaxant. By visit 4, pain decreased from 6.9±1.5 to 2.2±1.3 points. Pain was completely relieved in 77.0% of patients. 227 patients (6.9%) dropped out of observation, and 16.1% of patients continued the use of analgesics after four weeks of treatment. The vast majority of patients (88.4%) evaluated treatment results as "good" or "excellent". Switching to the other NSAID was required in 8.1% of patients, local injection of GC in 1.9%, administration of antidepressant or anticonvulsant in 1.5%, and hospitalization in 0.25% of patients. Adverse reactions (mostly dyspepsia) were noted in 2.2% of patients. <h3>Conclusions</h3> The use of treatment algorithm based on a complex pathogenetic approach ensures that patients receive an effective and relatively safe pain relief. Oral NSAIDs are the most expedient as first-line treatment in patients with moderate and severe musculoskeletal pain. <h3>Disclosure of Interest</h3> None declared