Personalized approach to choosing an analgesic for the treatment of musculoskeletal pain

Abstract

Chronic musculoskeletal pain (CMSP) associated with diseases of the musculoskeletal system is one of the global causes of suffering, disability, and a decrease in the quality of life and its duration for hundreds of millions of people on Earth. Therefore, effective pain control is among the first and most important tasks of the treatment of musculoskeletal diseases. For this purpose, a complex of medications and non-pharmacological approaches (kinesiotherapy, psychological methods, educational programs, etc.) is used. Effective, affordable and convenient nonsteroidal anti-inflammatory drugs (NSAIDs) play a fundamental role among analgesics. They belong to the “first line” drugs for the control of SMB. However, when prescribing them, it is necessary to take into account the presence of comorbid pathology as risk factors for drug complications. At the same time, naproxen is the safest NSAID in terms of cardiovascular risk. The effectiveness of this drug has been proven both in the short-term treatment of acute and long-term therapy of chronic pain. Naproxen is more effective than paracetamol and is not inferior to weak opioids and other NSAIDs, such as ibuprofen and ketorolac. The data of clinical, observational and cohort studies, as well as their meta-analysis, confirm that the risk of cardiovascular complications in the treatment with naproxen is minimal. An urgent problem in the treatment of CMSP is the combination of this pathology with sleep disorders, which determines a significant deterioration in the well-being and quality of life of patients. The use of the combined over-the-counter drug naproxen and diphenhydramine for short-term therapy of insomnia presents new possibilities of pharmacotherapy in this clinical situation.