.No is easy to discuss the treatment of osteoarthritis and pain control.

It is not, in fact, just take pharmcs for pain control (fans or synthetic opioids), but to treat and rehabilitate the individual.

So for the treatment of osteoarthritis of the cervical spine, it seems that active physical treatment, massage, movements which reactivate the function of the column and settle the altered posture of the spine are beneficial to the pain.



In particular:

Physical · Treatment: systematic reviews and randomized trials have found that therapy with EMF buttons compared to a simulated treatment, the exercise in relation to stress management and active physiotherapy compared to passive treatment significantly reduce the pain. Systematic reviews have found insufficient evidence on the effects of most physical treatments (hot or cold, traction, biofeedback, spray and stretch)

· Various studies have shown that manipulation and mobilization improves symptoms compared to other treatments. It still seems that the handling associated with strengthening exercises significantly reduces pain and increases patient satisfaction compared to each of the two treatments.

· Muscle relaxant therapy / benzodiazepines: A systematic review identified two RCTs (159 patients with chronic low back pain or neck pain with spasm acute), which compared three treatments: cyclobenzaprine (flexiban), diazepam and placebo. Both studies found that cyclobenzaprine significantly improved symptoms after two weeks than the other two treatments, but it was not possible to obtain quantitative data and follow-up about the pain. From a subsequent study (157 subjects with chronic neck pain) found that the eperisone (myonal) significantly improved pain control after 6 weeks compared to placebo.

· There are insufficient evidence on the effects of analgesics, NSAIDs, antidepressants and muscle relaxants, although these drugs are widely used as drugs of first level for neck pain. Many drugs used to treat neck pain are associated with adverse effects well documented.

In particular, we can say that the use of fans give a limited benefit in time and not conclusive.



What are the fans?

The nonsteroidal antiinflammatory drugs (NSAIDs) represent a heterogeneous series of compounds. Were traditionally classified by type of action: antirheumatic, pain-antifebbrili, reliever. They also wrongly called analgesics 'weak or light'. In fact, some of them, such as ketorolac, have an analgesic effect that is close to or less equivalent to opiates. Their mechanism of action is common and the origin of analgesia was due to:

inhibition of prostaglandin synthesis;

hyperpolarization of neuronal membrane;

inhibition of lysosomal enzymes;

depressed levels of oxidizing substances released in the formation of prostaglandins.

The actions for which NSAIDs are classically exploited are three: analgesic, antipyretic and antiphlogistic. The analgesic action is predominantly in peripheral location and exactly at the level of nociceptors. The antipyretic action consists of inhibition of prostaglandin biosynthesis in the hypothalamic thermoregulatory center. The anti-inflammatory action is not entirely clear. Prostaglandins, in addition to proinflammatory activity, increase the action of biological mediators of inflammation such as histamine and leukotrienes.





Name
Trade Name
Average dose in mg/24 h

Lysine acetylsalicylate
Flectadol
900x4

Acetylsalicylic acid
Aspirin
1000x4

Mefenamic acid
Lysalgo
250x3

Diclofenac
Voltaren
50x3

Diflunisal
Dolobid
500x3

Ibuprofen
Brufen
300x4

Ketoprofen
Orudis
100x3

Ketorolac tromethamine
Tora-Dol / Lixidol
30x4

Metamizole
Painkillers
500x3

Naproxen
Naprosyn
500x2

Nimesulide
Aulin
200x2

Paracetamol
Efferalgan
500x4

Piroxicam
Feldene
20x1








Major side effects of NSAIDs!

Eye on the gastric and duodenal ulcers! Protection should always be used with antacids or gastric ie pump inhibitors or anti-H2 (eg omeprazole, pantoprazole, ranitidine)

By interfering with platelet aggregation, they should be administered with caution in cancer patients with clotting problems, or with a reduced number of platelets.

Opioids

The drugs are derivatives of opium use old and proven effectiveness. These substances are also called analgesics opioid analgesics more, narcotics, morfinosimili.
Morphine is the founder and is the benchmark in the evaluation of analgesic its other congeners. They represent a stage, almost always obliged, in pain from cancer. Their potent analgesic activity is due to interaction with opioid receptors located in certain areas of the CNS and spinal cord along the sensory pathways of pain. At this level, similar to endorphins (a type of morphine normally produced by the body), they trigger mechanisms of elimination and modulation of painful sensations, coming as keys in the lock of pain and bloccandola.I different pharmacological profile of the individual opioids ( intensity of action, duration of action, side effects) are precisely explained by the existence of several varieties of different receptors and the ability of each drug morfinosimile to interact with individual receptors.

They are divided into drugs that act on opioid receptors in three groups according to the activity:

pure agonists (eg morphine)

agonist-antagonists (eg buprenorphine)

pure antagonists (eg naloxone).

Pure agonists and agonist-antagonists, while sharing a powerful analgesic activity should never be prescribed at the same time as, competing with the same receptor, reduce the therapeutic effect. In addition to the note and powerful anti-pain opioids produce certain other actions and side effects such as:


e-

tranquilizing action

respiratory depression

attenuation of the stimulus of cough

miosis

nausea and vomiting (central effects)

hypertonia of smooth muscle (constipation, impaired urination).



For osteoarthritis and pain from the back.

Clinical evidence

The problem is greater because it is not only to control pain but also to implement therapeutic interventions relevant surgery, found that shoulder surgery is not something simple to implement. There are no clinical trials on the effects of most surgical interventions in shoulder pain. A small randomized study reported that in subjects with frozen shoulder forced mobilization was more effective than intra-articular injection of steroids in the short term (3 months).

We found one RCT (30 patients with frozen shoulder divided into 2 groups of 15), where it was shown that the forced mobilization of the shoulder joint, associated intraarticular infiltration of hydrocortisone compared with hydrocortisone alone intraarticular infiltration led to a better recovery many more (7 / 15 vs 2 / 15 with only infiltration).



Subacromial cortisone infiltration.

A systematic review found limited evidence that subacromial steroid infiltration increases the range of movements, but no evidence of greater efficacy than placebo on pain. A randomized study found no evidence of positive effects on pain or the excursion of movement.

Intra-articular infiltration

Two systematic reviews found no clear evidence that the infiltration of intra-articular steroids best pain or range of motion compared to placebo. A small randomized study found that in subjects with frozen shoulder distension of the glenohumeral joint associated intra-articular infiltration of steroids can increase the range of movement and reduce the severity of symptoms compared to only intra-articular steroid infiltration.

NSAIDs and oral steroids.

Little evidence exists about the clinical use of NSAIDs and oral corticosteroids.



For the treatment of osteoarthritis of the knee problem is even more complex and often only resolvable with prosthetic knee, if there is no relevant neurological disease in the subject.
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