Neuromuscular DiseasesNeuromuscular DiseasesНервно-мышечные болезни2222-87212413-0443Publishing House ABV Press4510.17650/2222-8721-2013-0-2-20-26LECTURES AND REVIEWSЛЕКЦИИ И ОБЗОРЫA patient with back pain: therapy possibilitiesПациент с болью в спине: возможности терапииKamchatnovP. R.КамчатновП. Р.
Russian Federation
pavkam7@gmail.comChugunovA. V.ЧугуновА. В.
Russian Federation
TrubetskayaE. A.ТрубецкаяЕ. А.
Russian Federation
N.I. Pirogov Russian National Research Medical University, MoscowГБОУ ВПО «РНИМУ им. Н.И. Пирогова», Москва200620133220261902201519022015Copyright ©; 2013, Kamchatnov P.R., Chugunov A.V., Trubetskaya E.A.Copyright ©; 2013, Камчатнов П.Р., Чугунов А.В., Трубецкая Е.А.2013Kamchatnov P.R., Chugunov A.V., Trubetskaya E.A.Камчатнов П.Р., Чугунов А.В., Трубецкая Е.А.https://creativecommons.org/licenses/by/4.0https://nmb.abvpress.ru/jour/article/view/45

Low back pain (LBP) is one of the most common clinical syndromes associated with the high rate of temporary disability and sizable material costs. The choice of adequate therapy for LBP requires that primary diseases that can be responsible for the occurrence of pain should be excluded. While choosing an analgesic, there must be a balance between its efficacy and the possible risk for undesirable side effects. One of the drugs that have proven effective in treating patients with LBP is ketoprofen (ketonal), the diversity of whose formulations allows maximally individualized therapy.

Боль в нижней части спины (БНС) – один из наиболее распространенных клинических синдромов, ассоциированный с высокой частотой временной утраты трудоспособности и значительными материальными затратами. Выбор адекватной терапии пациентов с БНС требует исключения первичных заболеваний, способных обусловить возникновение боли. При выборе противоболевого препарата необходимо соблюдать баланс между эффективностью и возможным риском развития нежелательных побочных эффектов. Одним из препаратов, хорошо зарекомендовавших себя при лечении пациентов с БНС, является кетопрофен (кетонал), разнообразие лекарственных форм которого позволяет проводить максимально индивидуализированную терапию.

low back painpain syndromeradiculopathydorsalgiaradicular syndromeketoprofenketonalketonal duopersonified treatmentболь в нижней части спиныболевой синдромрадикулопатиядорсалгиякорешковый синдромкетопрофенкетоналкетонал дуоперсонифицированное лечение1. Chou R., Qaseem A., Snow V. et al. for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/ American Pain Society Low Back Pain Guidelines Panel. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147:478–91.Chou R., Qaseem A., Snow V. et al. for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/ American Pain Society Low Back Pain Guidelines Panel. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147:478–91.2. Luo X., Pietrobon R., Sun S. et al. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine. 2004; 29:79-86.Luo X., Pietrobon R., Sun S. et al. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine. 2004; 29:79-86.3. Luo X., Pietrobon R., Sun S. et al. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine. 2004;29:79–86.Luo X., Pietrobon R., Sun S. et al. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine. 2004;29:79–86.4. Chiu T., Leung A., Lam P. Neck pain in Hong Kong: a telephone survey on consequences and health service utilization. Spine (Phila Pa 1976). 2010;35(21):E1088–95.Chiu T., Leung A., Lam P. Neck pain in Hong Kong: a telephone survey on consequences and health service utilization. Spine (Phila Pa 1976). 2010;35(21):E1088–95.5. Никифоров А.С., Коновалов А.Н., Гусев Е.И. Клиническая неврология. В 3 т. М.: Медицина, 2002.Никифоров А.С., Коновалов А.Н., Гусев Е.И. Клиническая неврология. В 3 т. М.: Медицина, 2002.6. Montero-Marin J., Garcia-Campayo J., Fajo-Pascual M. et al. Sociodemographic and occupational risk factors associated with the development of different burnout types: the cross-sectional university of Zaragoza study. BMC Psychiatry 2011;11:49–56.Montero-Marin J., Garcia-Campayo J., Fajo-Pascual M. et al. Sociodemographic and occupational risk factors associated with the development of different burnout types: the cross-sectional university of Zaragoza study. BMC Psychiatry 2011;11:49–56.7. Никифоров А.С., Авакян Г.Н. Неврологические осложнения остеохондроза позвоночника. М.: Медпрактика, 2011. 256 с.Никифоров А.С., Авакян Г.Н. Неврологические осложнения остеохондроза позвоночника. М.: Медпрактика, 2011. 256 с.8. Крылов В.В., Гринь А.А. О грыжах межпозвонковых дисков и результатах лечения больных с этой патологией. Consilium medicum 2009;11(9): 5–10.Крылов В.В., Гринь А.А. О грыжах межпозвонковых дисков и результатах лечения больных с этой патологией. Consilium medicum 2009;11(9): 5–10.9. Данилов А.Б., Курганова Ю.М. Офисный синдром. РМЖ. Неврология 2012;8;1902–8.Данилов А.Б., Курганова Ю.М. Офисный синдром. РМЖ. Неврология 2012;8;1902–8.10. Есин Р.Г., Есин О.Р., Ахмадеева Г.Д., Салихова Г.В. Боль в спине. Казань, 2010. 272 с.Есин Р.Г., Есин О.Р., Ахмадеева Г.Д., Салихова Г.В. Боль в спине. Казань, 2010. 272 с.11. Castellsague J., Riera-Guardia N., Calingaert B. et al. Individual NSAIDs and upper gastrointestinal complications: a systematic review and meta-analysis of observational studies (the SOS project). Drug Saf 2012;35(12):1127–46.Castellsague J., Riera-Guardia N., Calingaert B. et al. Individual NSAIDs and upper gastrointestinal complications: a systematic review and meta-analysis of observational studies (the SOS project). Drug Saf 2012;35(12):1127–46.12. Насонов Е.Л. Нестероидные противовоспалительные препараты (перспективы применения в медицине). М.: Анко, 2000. 143 с.Насонов Е.Л. Нестероидные противовоспалительные препараты (перспективы применения в медицине). М.: Анко, 2000. 143 с.13. Johnell K., Fastbom J. Concomitant use of gastroprotective drugs among elderly NSAID/COX-2 selective inhibitor users: a nationwide register-based study. Clin Drug Investig 2008;28(11):687–95.Johnell K., Fastbom J. Concomitant use of gastroprotective drugs among elderly NSAID/COX-2 selective inhibitor users: a nationwide register-based study. Clin Drug Investig 2008;28(11):687–95.14. Spofford C., Ashmawi H., Subieta A. et al. Ketoprofen produces modality-specific inhibition of pain behaviors in rats after plantar incision. Anesth Analg 2009;109(6):1992–9.Spofford C., Ashmawi H., Subieta A. et al. Ketoprofen produces modality-specific inhibition of pain behaviors in rats after plantar incision. Anesth Analg 2009;109(6):1992–9.15. Matsumoto M., De Oliveira A., Ribeiro Jr. P. et al. Short-term administration of non-selective and selective COX-2 NSAIDs do not interfere with bone repair in rats. J Mol Histol 2008;39(4):381–7.Matsumoto M., De Oliveira A., Ribeiro Jr. P. et al. Short-term administration of non-selective and selective COX-2 NSAIDs do not interfere with bone repair in rats. J Mol Histol 2008;39(4):381–7.16. Walker J., Sheather B., Carmody J. et al. Nonsteroidal antiinflammatory drugs in rheumatoid arthritis and osteoarthritis. Support for the concept of "responder" and "nonresponder". Arthritis Rheum 1887;11:1944–54.Walker J., Sheather B., Carmody J. et al. Nonsteroidal antiinflammatory drugs in rheumatoid arthritis and osteoarthritis. Support for the concept of "responder" and "nonresponder". Arthritis Rheum 1887;11:1944–54.17. Secoli S., Padilha K., Litvoc J. Costeffectiveness analysis of the analgesic therapy of postoperative pain. Rev Lat Am Enfermagem 2008;16(1):42–6.Secoli S., Padilha K., Litvoc J. Costeffectiveness analysis of the analgesic therapy of postoperative pain. Rev Lat Am Enfermagem 2008;16(1):42–6.18. Jovic R., Dragicevic D., Komazec Z., Sabo A. Ketoprofen is superior to metamizole in relieving postoperative pain after head and neck tumor operation. J BUON 2008;13(4):519–23.Jovic R., Dragicevic D., Komazec Z., Sabo A. Ketoprofen is superior to metamizole in relieving postoperative pain after head and neck tumor operation. J BUON 2008;13(4):519–23.19. Barden J., Derry S., McQuay H., Moore R. Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults. Cochrane Database Syst Rev 2009;(4):CD007355.Barden J., Derry S., McQuay H., Moore R. Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults. Cochrane Database Syst Rev 2009;(4):CD007355.20. Riou B., Plaisance P., Lecomte F. Comparison of two doses of ketoprofen to treat pain: a double-blind, randomized, noninferiority trial. Fundam Clin Pharmacol 2012; doi: 10.1111/j. 1472-8206.2012.01072.x. [Epub ahead of print].Riou B., Plaisance P., Lecomte F. Comparison of two doses of ketoprofen to treat pain: a double-blind, randomized, noninferiority trial. Fundam Clin Pharmacol 2012; doi: 10.1111/j. 1472-8206.2012.01072.x. [Epub ahead of print].21. Le Loet X. Safety of ketoprofen in the eldery: a prospective study on 20000 patients. Scand J Rheumatol 1989;83:21–7.Le Loet X. Safety of ketoprofen in the eldery: a prospective study on 20000 patients. Scand J Rheumatol 1989;83:21–7.22. Naclério-Homem M., Deboni M., Rapoport A., Chin V. Effects of ketoprofen and diclofenac potassium on blood coagulation tests after removal of third molars. Quintessence Int 2009;40(4):321–5.Naclério-Homem M., Deboni M., Rapoport A., Chin V. Effects of ketoprofen and diclofenac potassium on blood coagulation tests after removal of third molars. Quintessence Int 2009;40(4):321–5.23. Jacqz-Aigrain E., Serreau R., Boissinot C. et al. Excretion of ketoprofen and nalbuphine in human milk during treatment of maternal pain after delivery. Ther Drug Monit 2007;29(6):815–8.Jacqz-Aigrain E., Serreau R., Boissinot C. et al. Excretion of ketoprofen and nalbuphine in human milk during treatment of maternal pain after delivery. Ther Drug Monit 2007;29(6):815–8.24. Насонов Е.Л., Чичасова Н.В. Кетопрофен: новые аспекты применения в ревматологической практике. Рос ревматол 1999;3:8–14.Насонов Е.Л., Чичасова Н.В. Кетопрофен: новые аспекты применения в ревматологической практике. Рос ревматол 1999;3:8–14.25. Федин А.И., Батышева Т.Т., Винецкий Я.Я., Козлов М.Ю. Кетонал в лечении острых дорсалгий. Леч нервн бол 2002;2(7):27–9.Федин А.И., Батышева Т.Т., Винецкий Я.Я., Козлов М.Ю. Кетонал в лечении острых дорсалгий. Леч нервн бол 2002;2(7):27–9.26. Чичасова Н.В., Иммаметдинова Г.Р., Каратеев А.Е. и др. Эффективность и безопасность кетопрофена (кетонала) при ревматоидном артрите (клинико-эндоскопическое исследование). Науч-практ ревматол 2001;1:47–52.Чичасова Н.В., Иммаметдинова Г.Р., Каратеев А.Е. и др. Эффективность и безопасность кетопрофена (кетонала) при ревматоидном артрите (клинико-эндоскопическое исследование). Науч-практ ревматол 2001;1:47–52.27. Le Loet X. Safety of ketoprofen in the eldery: a prospective study on 20000 patients. Scand J Rheumatol 1989;83:21–7.Le Loet X. Safety of ketoprofen in the eldery: a prospective study on 20000 patients. Scand J Rheumatol 1989;83:21–7.28. Kopečná E., Deščíková V., Vlček J., Mladá J. Adverse drug reaction reporting in the Czech Republic 2005-2009. Int J Clin Pharm 2011;33(4):683–9.Kopečná E., Deščíková V., Vlček J., Mladá J. Adverse drug reaction reporting in the Czech Republic 2005-2009. Int J Clin Pharm 2011;33(4):683–9.29. Johnell K., Fastbom J. Concomitant use of gastroprotective drugs among elderly NSAID/COX-2 selective inhibitor users: a nationwide register-based study. Clin Drug Investig 2008;28(11):687–95.Johnell K., Fastbom J. Concomitant use of gastroprotective drugs among elderly NSAID/COX-2 selective inhibitor users: a nationwide register-based study. Clin Drug Investig 2008;28(11):687–95.30. Gigante A., Tagarro I. Non-steroidal anti-inflammatory drugs and gastroprotection with proton pumpGigante A., Tagarro I. Non-steroidal anti-inflammatory drugs and gastroprotection with proton pumpinhibitors: a focus on ketoprofen/omeprazole. Clin Drug Investig 2012;32(4):221–33.31. Zippel H., Wagenitz A. A multicentre, randomised, double-blind study comparing the efficacy and tolerability of intramuscular dexketoprofen versus diclofenac in the symptomatic treatment of acute low back pain. Clin Drug Investig 2007;27(8):533–43.Zippel H., Wagenitz A. A multicentre, randomised, double-blind study comparing the efficacy and tolerability of intramuscular dexketoprofen versus diclofenac in the symptomatic treatment of acute low back pain. Clin Drug Investig 2007;27(8):533–43.32. Chou R., Qaseem A., Snow V. et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147:478–91.Chou R., Qaseem A., Snow V. et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147:478–91.33. Mason L., Moore R., Edwards J. et al. Topical NSAIDs for acute pain: a metaanalysis. BMC Fam Pract 2004;5:10. 34. Hussain A., Khan G., Shah S. et al.Mason L., Moore R., Edwards J. et al. Topical NSAIDs for acute pain: a metaanalysis. BMC Fam Pract 2004;5:10. 34. Hussain A., Khan G., Shah S. et al.Development of a novel ketoprofen transdermal patch: effect of almond oil as penetration enhancers on in-vitro and exvivo penetration of ketoprofen through rabbit skin. Pak J Pharm Sci 2012;25(1):227–32.35. Fulga I., Lupescu O., Spircu T. Local tolerability and effectiveness of Ketospray® 10% cutaneous spray solution. Panminerva Med 2012;54(1 Suppl 4):23–33.Fulga I., Lupescu O., Spircu T. Local tolerability and effectiveness of Ketospray® 10% cutaneous spray solution. Panminerva Med 2012;54(1 Suppl 4):23–33.36. Herwadkar A., Sachdeva V., Taylor L., Silver H. Low frequency sonophoresis mediated transdermal and intradermal delivery of ketoprofen. Int J Pharm 2012;423(2):289–96.Herwadkar A., Sachdeva V., Taylor L., Silver H. Low frequency sonophoresis mediated transdermal and intradermal delivery of ketoprofen. Int J Pharm 2012;423(2):289–96.37. Lin J., Zhang W., Jones A. et al. Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: metaanalysis of randomised controlled trials. BMJ, doi:10.1136/bmj.38159.639028.7C (published 30 July 2004).Lin J., Zhang W., Jones A. et al. Efficacy of topical non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis: metaanalysis of randomised controlled trials. BMJ, doi:10.1136/bmj.38159.639028.7C (published 30 July 2004).