Персонализированный подход к выбору анальгетика для лечения скелетно-мышечной боли

Хроническая скелетно-мышечная боль (СМБ), связанная с заболеваниями скелетно-мышечной системы, – одна из глобальных причин страданий, утраты трудоспособности, снижения качества жизни и ее продолжительности сотен миллионов жителей Земли. Поэтому эффективный контроль боли относится к числу первоочередных и наиболее важных задач лечения скелетно-мышечных заболеваний. С этой целью используется комплекс медикаментозных препаратов и нефармакологических подходов (кинезиотерапия, психологические методы, образовательные программы и др.). Принципиальную роль среди анальгетиков играют эффективные, доступные и удобные нестероидные противовоспалительные препараты (НПВП). Они относятся к препаратам «первой линии» для контроля СМБ. Однако при их назначении обязательно следует учитывать наличие коморбидной патологии как факторов риска лекарственных осложнений. При этом наиболее безопасным НПВП с точки зрения кардиоваскулярного риска является напроксен. Эффективность этого препарата доказана как при кратковременном лечении острой, так и при длительной терапии хронической боли. Напроксен превосходит по эффективности парацетамол и не уступает слабым опиоидам и другим НПВП, таким как ибупрофен и кеторолак. Данные клинических, наблюдательных и когортных исследований, а также их метаанализ подтверждают минимальный риск кардиоваскулярных осложнений при лечении напроксеном. Актуальной проблемой лечения СМБ является сочетание этой патологии с нарушениями сна, что определяет значительное ухудшение самочувствия и качества жизни пациентов. Применение комбинированного безрецептурного препарата напроксен и дифенгидрамина для кратковременной терапии инсомнии представляет новые возможности фармакотерапии в данной клинической ситуации.

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