Fixed combination of non-steroidal anti-inflammatory drug and muscle relaxant as the basis for rational therapy of pain syndromes: A review

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Abstract

The incidence of pain in the lower back ranges from 10% to 25% of all cases of algia. 37–64.7% of the world's population have muscle spasms of varying severity during an exacerbation of pain. The problem of pain therapy is far from being solved. Achieving greater or equal pain relief can be achieved through combination drug therapy, where drugs have different mechanisms of action or combine pharmacokinetic properties to produce a synergistic effect. Fixed combinations of non-steroidal anti-inflammatory drugs and a muscle relaxant (chlorzoxazone 500 mg and ibuprofen 400 mg) are the basis of rational therapy, allowing them to achieve a number of clinical and pharmacological advantages.

About the authors

Marina V. Putilina

Pirogov Russian National Research Medical University

Author for correspondence.
Email: profput@mail.ru
ORCID iD: 0000-0002-8655-8501

д-р мед. наук, проф., проф. каф. клинической фармакологии лечебного фак-та

Russian Federation, Moscow

References

  1. Nicholas M, Vlaeyen JWS, Rief W, et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019;160(1):28-37. doi: 10.1097/j.pain.0000000000001390
  2. Buchanan BK, Varacallo M. Sacroiliitis. Available at: https://www.ncbi.nlm.nih.gov/books/NBK448141. Accessed: 12.06.2023.
  3. Karaarslan F, Güneri FD, Kardeş S. Postdischarge rheumatic and musculoskeletal symptoms following hospitalization for COVID-19: prospective follow-up by phone interviews. Rheumatol Int. 2021;41(7):1263-71. doi: 10.1007/s00296-021-04882-8
  4. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-803. doi: 10.1007/s00586-018-5673-2
  5. Hales SM, Martin SB, Gu Q. Prevalence of prescription painkiller use among adults: United States, 2015–2018. NCHS Data Brief. 2020;369.
  6. Vamvakas A, Lawn T, Veronese M, et al. Neurotransmitter receptor densities are associated with changes in regional Cerebral blood flow during clinical ongoing pain. Hum Brain Mapp. 2022;43(17):5235-49. doi: 10.1002/hbm.25999
  7. Distribution of how often adults in the U.S. used medication in the past month to help them fall or stay asleep as of 2020. Available at: https://www.statista.com/statistics/1364381/adult-fequency-used-medication-to-fall-stay-asleep-us-distribution. Accessed: 12.06.2023.
  8. Путилина М.В., Вечорко В.И., Гришин Д.В., Сидельникова Л.В. Острые нарушения мозгового кровообращения, ассоциированные с коронавирусной инфекцией SARS-CoV-2 (COVID-19). Журнал неврологии и психиатрии им. С.С. Корсакова. 2020;120(12):109-17 [Putilina MV, Vechorko VI, Grishin DV, Sidelnikova LV. Acute cerebrovascular accidents associated with SARS-CoV-2 coronavirus infection (COVID-19). Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2020;120(12):109-17 (in Russian)]. doi: 10.17116/jnevro2020120121109
  9. Meroni R, Piscitelli D, Ravasio C, et al. Evidence for managing chronic low back pain in primary care: a review of recommendations from high-quality clinical practice guidelines. Disabil Rehabil. 2021;43(7):1029-43. doi: 10.1080/09638288.2019.1645888
  10. Каратеев А.Е., Насонов Е.Л., Ивашкин В.Т., и др. Рациональное использование нестероидных противовоспалительных препаратов: клинические рекомендации. Научно-практическая ревматология. 2018;56:1-29 [Karateev AE, Nasonov EL, Ivashkin VT, et al. Rational use of nonsteroidal anti-inflammatory drugs: clinical guidelines. Rheumatology Science and Practice. 2018;56:1-29 (in Russian)]. doi: 10.14412/1995-4484-2018-1-29
  11. Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochem Pharmacol. 2020;180:114147. doi: 10.1016/j.bcp.2020.114147
  12. Путилина М.В., Теплова Н.В. Возможности индивидуального подхода к выбору нестероидного противовоспалительного препарата для коморбидного пациента с учетом клинико-фармакологических характеристик препарата на примере класса оксикамов. Журнал неврологии и психиатрии им. С.С. Корсакова. 2022;122(7):36-41 [Putilina MV, Teplova NV. Possibilities of individual choice of NSAIDs on the example of the oxicam class, taking into account clinical and pharmacological characteristics. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2022;122(7):36-41 (in Russian)]. doi: 10.17116/jnevro202212207136
  13. Chang WJ. Muscle Relaxants for Acute and Chronic Pain. Phys Med Rehabil Clin N Am. 2020;31(2):245-54. doi: 10.1016/j.pmr.2020.01.005
  14. Peck J, Urits I, Crane J, et al. Oral Muscle Relaxants for the Treatment of Chronic Pain Associated with Cerebral Palsy. Psychopharmacol Bull. 2020;50(4 Suppl. 1):142-62.
  15. Fudin J, Raouf M. A Review of Skeletal Muscle Relaxants for Pain Management. Pract Pain Manag. 2016;16(5).
  16. Cashin AG, Folly T, Bagg MK, et al. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ. 2021;374:n1446. doi: 10.1136/bmj.n1446
  17. Schoonover J, Rubin SE. Should Muscle Relaxants Be Used as Adjuvants in Patients With Acute Low Back Pain? Am Fam Physician. 2022;105(3):221.
  18. Mathieson S, Kasch R, Maher CG, et al. Combination drug therapy for low back pain. Cochrane Database Syst Rev. 2019;2019(6):CD011982. doi: 10.1002/14651858.CD011982.pub2
  19. Путилина М.В., Теплова Н.В. Синергизм лекарственных препаратов как основа рациональной нейропротекции. Журнал неврологии и психиатрии им. С.С. Корсакова. 2022;122(5):17-22 [Putilina MV, Teplova NV. Drug synergism as a basis for rational neuroprotection. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2022;122(5):17-22 (in Russian)]. doi: 10.17116/jnevro202212205117
  20. Kumar S, Rani S, Siwach R, Verma P. To compare the efficacy and safety of fixed dose combination of thiocolchicoside and aceclofenac versus chlorzoxazone, aceclofenac and paracetamol in patients with acute lower backache associated with muscle spasm. Int J Appl Basic Med Res. 2014;4(2):101-5. doi: 10.4103/2229-516X.136789
  21. Patel HD, Uppin RB, Naidu AR, et al. Efficacy and Safety of Combination of NSAIDs and Muscle Relaxants in the Management of Acute Low Back Pain. Pain Ther. 2019;8(1):121-32. doi: 10.1007/s40122-019-0112-6
  22. EMA. Guideline on clinical development of fixed combination medicinal products. 2017. Available at: https://www.ema.europa.eu/en/documents/scientific-guideline/guideline-clinical-development-fixed-combination-medicinal-products-revision-2_en. Accessed: 06.12.2023.
  23. Godman B, McCabe H, Leong TD. Fixed dose drug combinations – are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries. Expert Rev Pharmacoecon Outcomes Res. 2020;20(1):1-26. doi: 10.1080/14737167.2020.1734456
  24. Błaszczyk B, Miziak B, Czuczwar P, et al. A viewpoint on rational and irrational fixed-drug combinations. Expert Rev Clin Pharmacol. 2018;11(8):761-71. doi: 10.1080/17512433.2018.1500895
  25. Raffa RB, Tallarida RJ, Taylor RJr, Pergolizzi JV Jr. Fixed-dose combinations for emerging treatment of pain. Expert Opin Pharmacother. 2012;13(9):1261-70. doi: 10.1517/14656566.2012.668531
  26. Rainsford KD. Pharmacology and Toxicology of Ibuprofen. In: Ibuprofen. Ed. KD Rainsford. Chichester: Wiley Blackwell, 2015. doi: 10.1002/9781118743614.ch5
  27. Bushra R, Aslam N. An overview of clinical pharmacology of Ibuprofen. Oman Med J. 2010;25(3):155-1661. doi: 10.5001/omj.2010.49
  28. Adatia A, Rainsford KD, Kean WF. Osteoarthritis of the knee and hip. Part II: therapy with ibuprofen and a review of clinical trials. J Pharm Pharmacol. 2012;64(5):626-36. doi: 10.1111/j.2042-7158.2012.01456.x
  29. Bradley JD, Brandt KD, Katz BP, et al. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med. 1991;325(2):87-91. doi: 10.1056/NEJM199107113250203
  30. Irizarry E, Restivo A, Salama M, et al. A randomized controlled trial of ibuprofen versus ketorolac versus diclofenac for acute, nonradicular low back pain. Acad Emerg Med. 2021;28(11):1228-35. doi: 10.1111/acem.14321
  31. Путилина М.В. Роль артериальной гипертензии в развитии хронического нарушения мозгового кровообращения. Журнал неврологии и психиатрии им. С.С. Корсакова. 2014;114(9):124-8 [Putilina MV. The role of arterial hypertension in the development of chronic cerebrovascular accident. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2014;114(9):124-8 (in Russian)].
  32. Janczura M, Kobus-Moryson M, Sip S, et al. Fixed-Dose Combination of NSAIDs and Spasmolytic Agents in the Treatment of Different Types of Pain-A Practical Review. J Clin Med. 2021;10(14):3118. doi: 10.3390/jcm10143118
  33. Childers MK, Borenstein D, Brown RL, et al. Low-dose cyclobenzaprine versus combination therapy with ibuprofen for acute neck or back pain with muscle spasm: a randomized trial. Curr Med Res Opin. 2005;21(9):1485-93. doi: 10.1185/030079905X61938
  34. Berry H, Hutchinson DR. Tizanidine and ibuprofen in acute low-back pain: results of a double-blind multicentre study in general practice. J Int Med Res. 1988;16(2):83-91. doi: 10.1177/030006058801600202
  35. Nielsen RV, Fomsgaard JS, Siegel H, et al. The effect of chlorzoxazone on acute pain after spine surgery. A randomized, blinded trial. Acta Anaesthesiol Scand. 2016;60(8):1152-60. doi: 10.1111/aas.12754
  36. Kumalo HM, Bhakat S, Soliman MES. Theory and applications of covalent docking in drug discovery: merits and pitfalls. Molecules. 2015;20(2):1984-2000. doi: 10.3390/molecules20021984
  37. Wambaugh MA, Denham ST, Ayala M, et al. Synergistic and antagonistic drug interactions in the treatment of systemic fungal infections. Elife. 2020;9:e54160. doi: 10.7554/eLife.54160
  38. Friedman BW, Irizarry E, Solorzano C, et al. A Randomized, Placebo-Controlled Trial of Ibuprofen Plus Metaxalone, Tizanidine, or Baclofen for Acute Low Back Pain. Ann Emerg Med. 2019;74(4):512-20. doi: 10.1016/j.annemergmed.2019.02.017
  39. Громова О.А., Торшин И.Ю., Путилина М.В., и др. О механизмах синергидного действия толперизона, мелоксикама и витаминов группы В в терапии периферических болевых синдромов. Медицинский Совет. 2020;(8):54-64 [Gromova OA, Torshin IYu, Putilina MV, et al. On the mechanisms of the synergistic action of tolperisone, meloxicam and B vitamins in the treatment of peripheral pain syndromes. Meditsinskiy sovet = Medical Council. 2020;(8):54-64 (in Russian)]. doi: 10.21518/2079-701X-2020-8-54-64
  40. Путилина М.В. Эндотелий – мишень для новых терапевтических стратегий при сосудистых заболеваниях головного мозга. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017;117(10):122-30 [Putilina MV. Endothelium as a target for new therapeutic strategies in cerebral vascular diseases. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2017;117(10):122-30 (in Russian)]. doi: 10.17116/jnevro2017117101122-130
  41. Alviña K, Khodakhah K. KCa channels as therapeutic targets in episodic ataxia type-2. J Neurosci. 2010;30(21):7249-57. doi: 10.1523/JNEUROSCI.6341-09.2010
  42. Al-Ameri LT, Issa SB, Marzook AA, et al. Efficacy of Chlorzoxazone versus Orphenadrine in the management of pain associated with cervical spondylosis. RMJ. 2018;43(3):488-90.
  43. Chlorzoxazone. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/Chlorzoxazone#section=Metabolism-Metabolites. Accessed: 06.12.2023.
  44. Marinina KS, Bezprozvanny IB, Egorova PA. A chlorzoxazone-folic acid combination improves cognitive affective decline in SCA2-58Q mice. Sci Rep. 2023;13(1):12588. doi: 10.1038/s41598-023-39331-y
  45. Каратеев А.Е. Дестабилизация артериальной гипертензии как осложнение терапии нестероидными противовоспалительными препаратами: значение проблемы. Современная ревматология. 2018;12(2):64-72 [Karateev AE. Destabilized hypertension as a complication of therapy with nonsteroidal anti-inflammatory drugs: the importanceof the problem. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2018;12(2):64-72 (in Russian)]. DOI:10/14412/1996-7012-2018-2-64-72

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