chondroitin-sulfates and Low-Back-Pain

Authors reviewed the literature on the efficacy of chondroprotectors in the treatment of chronic pain syndromes in comparison with placebo and other analgesics to discover the own antinociceptive effect of these drugs and mechanisms by which it occurs. Authors evaluated the results of various clinical studies on the effect of symptomatic slow-acting drugs for osteoarthritis (SYSADOA) on chronic pain syndrome in osteoarthritis and low back pain. We compared their effects with those of NSAIDs, celecoxib, or placebo. Assessment of pain and functional status was performed using WOMAC, VASandLeken's index as well as the Roland--Morrisquality of life questionnaire. The review of a number of clinical studies revealed a definite antinociceptive and anti-inflammatory effect of SYSADOA comparable with NSAIDs not only in the treatment of osteoarthritis, but also in chronic back pain, which is characterized by early onset and gradual development with a long-term retention of the result even after discontinuation of therapy. It has been shown that SYSADOA are able to reduce the level of inflammatory cytokines in the blood (IL-6, C-reactive protein) and to activate the production of anti-inflammatory cytokine IL-10 in the synovial membrane. It is shown that blocking of the effects of interleukin 1-beta and thereby inhibition of inflammatory enzymes like nitric oxide synthase and cyclooxygenase-2 is one of the points of glucosamine chondrocytes application. The data obtained in numerous studies that confirm the ability of SYSADOA to inhibit proinflammatory cytokines open the new perspectives for their use in the treatment of not only joint pain but also other chronic pain syndromes.. Обзор посвящен изучению эффективности назначения хондропротекторов при хронических болевых синдромах в сравнении с плацебо и другими анальгетиками с целью уточнения собственного антиноцицептивного эффекта этих препаратов и механизмов, за счет которых он осуществляется. Была проведена оценка результатов различных клинических исследований по влиянию хондропротекторов на хронический болевой синдром как при остеоартрозе, так и люмбалгии. Изучалось сравнение их эффектов с нестероидными противовоспалительными средствами (НПВС), целекоксибом, плацебо. Оценка болевого синдрома и функционального состояния проводилась по шкалам WOMAC, Лекена и ВАШ, а также по опроснику качества жизни Роланда-Морриса. В ходе обзора ряда клинических исследований выявлен выраженный антиноцицептивный эффект хондропротекторов, сравнимый с таковым у НПВС не только при терапии остеоартроза, но и при хронической боли в спине, характеризующийся ранним началом и постепенным развитием с длительным сохранением результата даже после отмены терапии. Показано, что хондропротекторы способны снижать уровень противовоспалительных цитокинов в крови, таких как интерлейкин-6 (IL-6), С-реактивный белок, и активировать выработку антивоспалительных цитокинов IL-10 в синовиальной мембране. Показано, что одной из точек приложения глюкозамина в хондроцитах является блокирование эффектов интерлейкина-1β, посредством чего также ингибируются воспалительные ферменты, такие как синтаза оксида азота и циклооксигеназа-2. Полученные в многочисленных исследованиях данные, подтверждающие способность хондропротекторов ингибировать провоспалительные цитокины, открывают новые перспективы их применения в терапии не только артралгий, но и других хронических болевых синдромов.

Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; C-Reactive Protein; Celecoxib; Chondroitin Sulfates; Chronic Pain; Cyclooxygenase 2 Inhibitors; Cytokines; Drug Combinations; Glucosamine; Humans; Interleukin-10; Interleukin-6; Low Back Pain; Nociceptive Pain; Osteoarthritis; Randomized Controlled Trials as Topic; Syndrome

To study an analgesic role of melatonin in the treatment of low back pain.. A study included 178 patients, aged from 40 to 65 years, with low back pain during at least 12 weeks and the VAS score > 3. Patients were stratified into 6 groups (3 pairs of comparison). In the first pair, patients of the main group (n = 31) received APTPA (a combination of 500 mg of glucosamine hydrochloride and 500 mg of chondroitin sulfate) in dosage 1 tablet twice a day during 1 month and then 1 tablet during 2 months plus melaxen (3 mg of melatonin 30-40 min before sleep), patients of the control group (n = 29) received only APTPA. In the second pair, patients of the comparison group (n = 30) received APTPA in dosage 1 tablet twice a day and diclofenac in dosage 25 mg 2-3 times a day, patients of the main group (n = 30) received additionally melaxen (3 mg of melatonin 30-40 min before sleep). In the third pair, patients of the main group (n = 29) received APTPA in dosage 1 tablet twice a day, diclofenac in dosage 25 mg 2-3 times a day and melaxen (3 mg of melatonin 30-40 min before sleep), patients of the comparison group (n = 29) did not receive melaxen. Treatment results were assessed after 3 months for the first pair and after 1 month for the second and third pairs.. A significant reduction in pain intensity at movement and resting state was noted in the main groups compared to controls.. Possible mechanisms of analgesic properties of melatonin and world experience in chronic low back pain treatment are discussed.. Цель исследования - изучение анальгетической роли мелатонина в терапии хронической боли в спине. Материал и методы. В исследование были включены 178 пациентов в возрасте от 40 до 65 лет, страдавшие болью в нижней части спины длительностью не менее 12 нед и интенсивностью более 3 баллов по визуальной аналоговой шкале. Пациенты были разделены на 6 групп и составили 3 пары сравнения. В 1-й паре больные основной группы (31 человек) получали препарат артра (комбинация глюкозамина гидрохлорида 500 мг и хондроитина сульфата 500 мг) по 1 таблетке 2 раза в день на протяжении 1 мес, затем по 1 таблетке в течение 2 мес и дополнительно мелаксен (мелатонин 3 мг за 30-40 мин до сна), пациенты из группы сравнения (29) получали только препарат артра. Во 2-й паре больные группы сравнения (30) принимали препарат артра по 1 таблетке 2 раза в день и диклофенак в дозе 25 мг 2-3 раза в день, пациенты из основной группы (30) дополнительно принимали мелаксен по аналогичной применяемой в 1-й паре сравнения схеме. В 3-й паре больные основной группы (29) получали диклофенак в дозе 25 мг 3 раза в день и мелаксен по описанной выше схеме, пациенты из группы сравнения (29) не получали мелаксен. Результаты оценивались в 1-й паре через 3 мес, во 2-й и 3-й - через 1 мес. Результаты и заключение. Полученные данные свидетельствуют о статистически значимо более выраженном снижении интенсивности боли при движении и в покое во всех основных группах, чем в группах сравнения. Обсуждаются возможные механизмы анальгетических свойств мелатонина и мировой опыт его применения в терапии хронической боли. Сделан вывод, что добавление мелатонина к стандартной схеме лечения повышает его эффективность.

Topics: Adult; Aged; Analgesics; Antioxidants; Chondroitin Sulfates; Diclofenac; Female; Humans; Low Back Pain; Male; Melatonin; Middle Aged; Pain Measurement; Tablets

To study analgesic possibilities of melatonin.. A study included 120 patients, aged from 40 to 65 years, with low back pain. Duration of illness was not less than 12 weeks, the VAS score was >3. Patients were stratified into 4 groups (2 pairs of comparison). In the first pair, patients of the main group (n=31) received a chondroprotector АРТРА with the addition of melaxen (melatonin in dose 3 mg) and patients of the control group (n=29) received only АРТРА. In the second pair, patients of the control group (n=30) were treated with АРТРА and diclofenac and patients of the main group (n=30) received additionally melaxen. Treatment efficacy was assessed after 3 months for the first pair and after 1 month for the second pair.. A significant reduction in pain intensity at both resting state and movement was noted in main groups compared to controls.. Due to its therapeutic efficacy and good tolerability, melatonin may be regarded as a drug of choice in the complex treatment of chronic pain syndromes. Possible analgesic properties of melatonin and their mechanisms are discussed.

Topics: Adult; Chondroitin Sulfates; Diclofenac; Female; Glucosamine; Humans; Low Back Pain; Male; Melatonin; Middle Aged; Treatment Outcome

To assess duration of a clinical response and tolerance of structum in patients with low back pain (LBP) and comorbid cardiovascular disease.. 25 patients with primary LBP and coronary heart disease (n = 13) and/or essential arterial hypertension (n = 18) were examined and treated for 6 months with structum.. To the end of the first treatment months structum significantly relieved pain intensity, spinal motility, increased exercise tolerance. Excellent and good response to structum were observed in 71% patients, no response was in 29%. Tolerance of the drug was good in 23 (92%) patients. The effect persisted for 3 months. CHD characteristics did not change while arterial pressure went down noticiably.. Structum is highly effective in the treatment of LBP. Its long-term intake had no effect on CHD.

Topics: Adult; Aged; Chondroitin Sulfates; Coronary Disease; Drug Therapy, Combination; Enalapril; Exercise Tolerance; Female; Humans; Hypertension; Low Back Pain; Male; Middle Aged; Syndrome; Treatment Outcome

A prospective experimental study.. To investigate the potential of serum keratan sulfate (KS) as an indicator of biochemical changes in intervertebral discs induced by physical loading of the back.. By providing objective information on exposure and effects at the tissue level, biomarkers may enable us to improve our understanding of the intermediate steps between exposure to physical loading and the occurrence of back disorders. Serum KS has been proposed as a potential biomarker of the molecular changes in intervertebral discs that occur because of physical loading and are a potential cause of back disorders.. Thirty-two nonimpaired men volunteers with a mean age of 22.5+/-2.3 years participated in the experimental condition, a manual lifting task, as well as in the control condition, lying on the back. Serum KS levels were measured immediately before and after both conditions, as well as 24 hours and 1 week later.. No significant changes in serum KS levels were found after exposure to physical loading (mean SD serum KS before, 287.4+/-83.9 ng/mL; immediately after, 279.5+/-65.5 ng/mL; 24 hours after, 266.6+/-71.9 ng/mL; and 1 week after, 268.9+/-79.3 ng/mL), and no significant changes were found after lying on the back for 8 hours (mean+/-SD serum KS before, 273.0+/-94.3 ng/mL; immediately after, 261.6+/-68.9 ng/mL; 24 hours after, 277.3+/-68.9 ng/mL; and 1 week after, 274.5+/-68.5 ng/mL).. These results indicate that the serum KS level is not suitable as a biomarker of the effects of short-term physical loading of the back induced by a manual lifting task.

Topics: Adult; Aggrecans; Analysis of Variance; Biomarkers; Chondroitin Sulfates; Extracellular Matrix Proteins; Humans; Keratan Sulfate; Lectins, C-Type; Lifting; Low Back Pain; Male; Prospective Studies; Proteoglycans; Rest; Stress, Mechanical; Weight-Bearing

To evaluate the antiresorptive-cytokine effects of chondroitin sulfate on non-specific lower back pain in patients with knee osteoarthritis (OA).. Using the envelope method, 231 patients were randomized into two groups: group 1 (. At the end of the study, there is a significant decrease in all studied cytokines in patients of group 1 compared to group 2, as well as indicators of beta-Crosslaps (. Оценка антирезорбтивно-цитокиновой эффективности хондропротективной терапии хондроитина сульфатом неспецифической боли в нижней части спины у пациентов с остеоартритом (ОА) коленных суставов.. Методом конвертов проведена рандомизация в две группы 231 пациента с болью в нижней части спины: больные 1-й группы (. На момент окончания исследования получены результаты статистически значимого снижения всех изучаемых цитокинов у пациентов 1-й группы в сравнении с пациентами 2-й группы, а также показателей Beta-Crosslaps (

Topics: Anti-Inflammatory Agents, Non-Steroidal; Chondroitin Sulfates; Cytokines; Humans; Low Back Pain; Osteoarthritis, Knee

To study the efficacy and safety of chondroitin sulfate (mucosat) in the treatment of chronic lower back pain.. The medical documentation of 46 outpatients with chronic lumbosacral dorsalgia, who received 25 intramuscular injections of 2 ml mucosat, was studied. The assessment of patients' condition and efficacy and safety of the treatment was conducted based on the data of four visits (1-st, 10-th and 25-th day and 3 months after the end of treatment). Results of the clinical-neurological examination, pain intensity at rest and at movement according to the Visual Analogue Scale (VAS) and the severity of Lasegue and Wasserman signs and limitation of movements in the lumbar spine were taken into account.. The use of mucosat at a dose of 2 ml intramuscularly 1 time in 2 days led to a significant decrease in the severity of pain syndrome and increased mobility in the lumbar spine (before treatment, the level of pain at rest according to the VAS was 4.22±1.28 scores, on the 25-th day 2.13±0.24, 3 month after treatment 2.37±0.31; the level of pain at movement: 5.78±1.15; 4.56±0.47; 4.78±0.22, respectively (p<0.01). There were a reduction of the dose of previously used non-steroidal anti-inflammatory drugs in the end of treatment and maintenance of the results of therapy for 3 months after the end of treatment. Good tolerability of the drug and the absence of significant side-effects were shown as well.. This study showed the efficacy and safety of chondroitin sulfate (mucosat) in the treatment of outpatients with chronic lower back pain.. Цель исследования. Определение эффективности и безопасности применения хондроитина сульфата (мукосат) в терапии хронической боли в нижней части спины. Материал и методы. Изучена медицинская документация 46 пациентов с хронической пояснично-крестцовой дорсалгией, получивших в условиях поликлиники курс 25 внутримышечных инъекций 2 мл препарата 'Мукосат'. Оценку состояния больных, эффективности и безопасности лечения проводили, исходя из информации, полученной в ходе четырех визитов (на 1, 10 и 25-й день терапии и через 3 мес после окончания курса лечения). Учитывали данные клинико-неврологического обследования, оценку интенсивности боли в покое и при движении по визуально-аналоговой шкале (ВАШ), выраженность симптомов Ласега и Вассермана, степень ограничения подвижности в поясничном отделе позвоночника. Результаты. Применение мукосата привело к достоверному снижению выраженности болевого синдрома. Уровень боли в покое по шкале ВАШ до лечения составлял 4,22±1,28 балла, на 25-й день терапии - 2,13±0,24 балла, через 3 мес после окончания курса лечения - 2,37±0,31 балла; уровень боли при движении - 5,78±1,15, 4,56±0,47 и 4,78±0,22 балла соответственно (р<0,01). Также были отмечены увеличение подвижности в поясничном отделе позвоночника, сокращение дозы ранее применяемых нестероидных противовоспалительных препаратов к концу курса лечения и сохранение результатов терапии через 3 мес после окончания курса лечения. Проведенный курс лечения показал хорошую переносимость препарата и отсутствие значимых побочных эффектов. Заключение. Результаты исследования свидетельствуют об эффективности и безопасности хондроитина сульфата (мукосат) в терапии амбулаторных пациентов с хроническим болевым синдромом в нижней части спины.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Back Pain; Chondroitin Sulfates; Humans; Low Back Pain; Lumbar Vertebrae; Treatment Outcome

Chondroprotectors (CP) are biological agents that contribute to the regeneration of the cartilage surfaces, joint capsule, participating in the metabolism of the articular cartilage. Progressive loss of hyaline cartilage and a decrease in chondroitin sulfate (CS) is observed in osteoarthritis (OA) including low back pain. OA therapy is aimed at slowing disease progression, relief of pain symptoms, reduction of functional disorders. With this purpose, orally or injectable CP (chondroguard) are used. The optimal dosing regimen for the parenteral forms of CP is recommended: 3 injections of 1 ml (100mg) of chondroguard introduction for 1 week, 2 ml (200mg) from the 4-th injection, 25-30 injections at 200 mg in a day, with a second 6 month course.. Хондропротекторы - биологические препараты, которые способствуют регенерации хрящевых поверхностей и суставной сумки, участвуя в обменных процессах суставного хряща. Прогрессивная потеря гиалинового хряща, уменьшение количества хондроитина сульфата наблюдаются при остеоартрозе различной локализации, в том числе при дорсопатии. Терапия остеоартроза направлена на замедление прогрессирования заболевания, облегчение болевых симптомов, уменьшение функциональных нарушений. С этой целью назначают пероральные или инъекционные формы хондропротекторов (хондрогард). Оптимальный режим дозирования при назначении парентеральных форм хондропротекторов: хондрогард внутримышечно первые 3 инъекции по 1 мл (100 мг), начиная с 4-й инъекции - по 2 мл (200 мг), 25-30 инъекций по 200 мг внутримышечно через день, повторный курс через 6 мес.

Topics: Cartilage, Articular; Chondroitin Sulfates; Humans; Injections; Low Back Pain; Osteoarthritis

Intervertebral disc (IVD) degeneration is strongly associated with low back pain, a major cause of disability worldwide. An in-depth understanding of IVD cell physiology is required for the design of novel regenerative therapies. Accordingly, aim of this work was the study of IVD cell responses to mitogenic growth factors in a three-dimensional (3D) organotypic milieu, comprising characteristic molecules of IVD's extracellular matrix. In particular, annulus fibrosus (AF) cells were cultured inside collagen type-I gels, while nucleus pulposus (NP) cells in chondroitin sulfate A (CSA) supplemented collagen gels, and the effects of Platelet-Derived Growth Factor (PDGF), basic Fibroblast Growth Factor (bFGF), and Insulin-Like Growth Factor-I (IGF-I) were assessed. All three growth factors stimulated DNA synthesis in both AF and NP 3D cell cultures, with potencies similar to those observed previously in monolayers. CSA supplementation inhibited basal DNA synthesis rates, without affecting the response to growth factors. ERK and Akt were found to be phosphorylated following growth factor stimulation. Blockade of these two signaling pathways using pharmacologic inhibitors significantly, though not completely, inhibited growth factor-induced DNA synthesis. The proposed culture systems may prove useful for further in vitro studies aiming at future interventions for IVD regeneration.

Topics: Animals; Cattle; Chondroitin Sulfates; Collagen; DNA; Fibroblast Growth Factor 2; Humans; Insulin-Like Growth Factor I; Intervertebral Disc; Intervertebral Disc Degeneration; Low Back Pain; Organ Culture Techniques; Platelet-Derived Growth Factor; Regenerative Medicine; Signal Transduction

Characterization of the analytic profile of proteoglycans in the intervertebral discs at L4-L5 of nondiabetic (n = 5) and diabetic (n = 5) age-matched subjects. The discs used were discarded material from operations.. To clarify the reason for the higher risk of disc prolapse in diabetic patients.. The pathogenesis of diabetes results from a combination of neurologic dysfunctions and a yet undefined metabolic failure, which leads to an abnormal proteoglycan profile.. The following methods were used to determine the proteoglycan profile: the measurement of 35S-sulfate uptake per gram wet tissue into sulfated glycosaminoglycan using fresh tissue explants; extraction of proteoglycans by 4 M guanidinium chloride containing protease inhibitors, with further purification by ultracentrifugation on cesium chloride buoyant density gradient under dissociative conditions; total uronic acid and protein contents in the various gradient fractions; assessing the length of sugar side chains of isolated 35Sulfate-glycosaminoglycan molecules by separation of the glycosaminoglycan molecules on a Sepharose 6B-CL column; and paper chromatography of the final digest products of glycosaminoglycan molecules obtained by chondroitinase ABC, a glycosaminoglycan-degrading enzyme.. The findings show that discs from normal nondiabetic subjects have 15 times the rate of 35Sulfate incorporation into glycosaminoglycan molecules than do discs of diabetic patients. The proteoglycans of diabetic patients are banded at a lower buoyant density, indicating a lowered glycosylation rate and a lower number of sugar side chains per core protein. In discs of diabetic patients, there is a slight increase in the chain length of chondroitin sulfate. Further analysis of the glycosaminoglycan chains showed a decreased amount of keratan sulfate, compared with that in nondiabetic subjects. However, the total uronic acid content of the disc tissues and the ratio of uronic acid to protein of each fraction were unchanged in diabetic patients versus that in control subjects.. Discs in patients with diabetes have proteoglycans with lower buoyant density and substantially undersulfated glycosaminoglycan, which with the specific neurologic damage in these patients, might lead to increased susceptibility to disc prolapse.

Topics: Aged; Chondroitin Sulfates; Chromatography, Gas; Diabetes Complications; Diabetes Mellitus; Female; Glycosaminoglycans; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Keratan Sulfate; Low Back Pain; Lumbar Vertebrae; Male; Middle Aged; Proteoglycans; Uronic Acids