CONTROLLED-RELEASE OXYCODONE IN THE TREATMENT OF CHRONIC MUSCULOSKELETAL PAIN: A PRELIMINARY EXPERIENCE OF A RHEUMATOLOGY CENTER

U etiologiji nemaligne boli znatan udio bolesnika ima boli podrijetla mišićno-koštanog sustava. Uporaba jakih opioida u liječenju nemaligne boli još je prijeporna. Stoga je cilj istraživanja bio utvrditi učinkovitost i podnošljivost oksikodona s postupnim otpuštanjem aktivne tvari (CR) u liječenju bolesnika s nedovoljno kontroliranom boli mišićno-koštanog podrijetla, a u ovom radu iznose se preliminarni rezultati. U ovome prospektivnom, otvorenom, opservacijskom istraživanju jednoga reumatološkog centra tercijarne zaštite konsekutivno su bili uključeni bolesnici s različitim bolestima mišićno-koštanog podrijetla koji su unatoč primjeni lijekova protiv boli osjećali umjerenu do jaku bol. Bolesnici su bili prebačeni na terapiju oksikodonom CR i praćeni 14 dana. Početna doza lijeka bila je 10 mg na dan, a potom je doza ovisno o potrebi povisivana. Primarni cilj bio je ispitati učinkovitost oksikodona na intenzitet boli, a sekundarni cilj istraživanja bio je ispitati učinkovitost na opće zdravlje bolesnika (oboje na vizualno-analognoj skali, VAS 0 – 10). U studiju je bilo uključeno 15 bolesnika (12 žena, 3 muškarca) prosječne dobi 61 ± 12 godina, s dijagnozama osteoartritisa, lumboishialgije i upalnih artritisa. Bol je trajala 41 ± 12 mjeseci. Prije početka liječenja oksikodonom CR jačina boli bila je 7,87 ± 2,28 (raspon 7 – 10), a na kraju praćenja 5,92 ± 2,43 (raspon 4 – 9) (p = 0,069). Također, opće zdravstveno stanje bilo je ocijenjeno 7,27 ± 2,14 (raspon 3 – 10) prije početka, a 6,00 ± 1,53 (raspon 3 – 9) na kraju praćenja (p = 0,028). Dva su bolesnika tijekom istraživanja prekinula primjenu lijeka; jedan zbog nuspojava (mučnina i vrtoglavica), a drugi zbog straha i mišljenja da mu lijek nakon 2 dana primjene nedovoljno smanjuje bol. Profi l nuspojava oksikodona bio je očekivan. Rezultati našeg preliminarnog istraživanja pokazuju da je u bolesnika s kroničnom nemalignom boli mišićno- -koštanog podrijetla, u kojih bol nije dobro kontrolirana jednostavnim analgeticima, nesteroidnim antireumaticima i slabim opijatima, liječenje oksikodonom s kontroliranim otpuštanjem aktivne tvari znatno smanjilo razinu boli i poboljšalo opće zdravlje bolesnika.In the etiology of non-malignant pain, a signifi cant proportion is constituted by patients with pain originatng in the musculoskeletal system. Th e use of strong opioids in the treatment of non-malignant pain is still controversial. Th erefore, the aim of this study was to establish the effi cacy and safety of oxycodone with a controlled release of the active substance (CR) in the treatment of patients with chronic, not well-controlled musculoskeletal pain. Here we present our preliminary results. In this prospective, open, single-center study conducted at a rheumatology center we enrolled consecutive patients with musculoskeletal pain due to a variety of musculoskeletal diseases (osteoarthritis, pain in the lower back, spondyloarthritis), who suff ered from moderate to severe pain despite previous analgesic therapy (with NSAIDs, weak opioids, or a fi xed combination of paracetamol and weak opioids). Patients were switched to therapy with oxycodone CR and followed for 14 days. Th e starting dose of oxycodone CR was 10 mg, and later the dose was adapted as necessary. Th e primary endpoint was to assess the eff ectiveness of oxycodone CR on pain intensity, and the secondary goal was to assess the effi ciency on the general health of the patient (both on a horizontal visual analogue scale, VAS 0 = best, 10 = worst). Fift een patients (12 women, 3 men), with a mean age of 61 ± 12 years and a diagnosis of osteoarthritis, pain in the lower back, or infl ammatory arthritis, were included in the study. Th e duration of pain was 41 ± 12 months. Th e average intensity of pain before oxycodone CR treatment was 7.87 ± 2.28 (range 7-10), and at the end of the study it was 5.92 ± 2.43 (range 4-9) (p=0.069). General health was rated 7.27 ± 2.14 (range 3-10) before the start and 6.00 ± 1.53 (range 3-9) at the end of the study (p=0.028). In one patient the treatment was discontinued due to dizziness and nausea, and one patient voluntarily left the study because of fear and the subjective impression of no adequate pain control aft er 2 days of treatment. Th e oxycodone side-eff ect profi le was as expected. Results of our preliminary study show that in patients with chronic non-malignant pain which is not well controlled by simple analgesics, NSAIDs, and weak opioids, treatment with oxycodone CR contributed to a signifi cant reduction in the level of pain and improved the general health of the subjects

The effectiveness of balneotherapy/hydrotherapy on functional abilities, activities and quality of life of patients with rheumatoid arthritis

Balneoterapija/hidroterapija neizostavni je dio rehabilitacije bolesnika s upalnim reumatskim bolestima. Kako se njena učinkovitost često dovodi u pitanje, cilj rada je bio utvrditi učinkovitost balneoterapije/hidroterapije na funkcionalne sposobnosti, aktivnosti i kvalitetu života bolesnika s reumatoidnim artritisom (RA). U kliničku studiju su uključena 113 bolesnika s RA-om, 79 žena i 34 muškarca, koji su liječeni u Specijalnoj bolnici za medicinsku rehabilitaciju Varaždinske Toplice, u prosječnom trajanju 14 dana. Prije i poslije balneoterapije, pacijenti su ispunili upitnik o procjeni zdravlja HAQ (Health assessment questionnaire) i upitnik o kvaliteti života bolesnika s Izvorni znanstveni članak Original scientific article ISSN 1846-1867 reumatoidnim artritisom QoL-RA (Quality of life RA). Ocjena aktivnosti bolesti DAS 28 korištena je za mjerenje djelovanja bolesti prije i poslije balneoterapije/ hidroterapije. Pronašli smo značajno poboljšanje funkcionalne sposobnosti u bolesnika s RA-om. Prosječna ocjena HAQ-a prije balneoterapije/hidroterapije je 1,07 + / - 0,61, i 0,84 + / - 0,55, nakon balneoterapije/hidroterapije, što je statistički značajno niži (p <0,05). DAS 28 nakon balneoterapije/hidroterapije je i statistički značajno niži od DAS 28 prije balneoterapije/hidroterapije: srednja vrijednost DAS 28 prije balneoterapije/hidroterapije bila je 6,30 + / - 0,81 i nakon balneoterapije/hidroterapije 5,45 + / - 0,75 (p <0,01). Kvaliteta života značajno je poboljšana nakon balneoterapije/hidroterapije: srednja vrijednost QoL-RA prije balneoterapije/hidroterapije je bila 5,38 + / - 1,62 i nakon baleoterapije/hidroterapije 7,37 + / - 1,81 (p <0,05). Zaključno, balneoterapija/hidroterapija, kada se pravilno dozira, učinkovita je terapija u liječenju bolesnika s RA-om. Balneoterapija/hidroterapija ima pozitivan utjecaj na funkcionalne sposobnosti, aktivnosti bolesti i kvalitetu života bolesnika s reumatoidnim artritisom.Balneotherapy/hydrotherapy is an essential part of the rehabilitation of patients with inflammatory rheumatic diseases. Given that its effectiveness is often questioned, the goal of the study was to determine the effectiveness of balneotherapy/hydrotherapy on functional abilities, activities and quality of life of patients with rheumatoid arthritis (RA). The clinical study included 113 RA patients, 79 women and 34 men, who were treated in the Special Hospital for Medical Rehabilitation Varazdin Spa, with the average duration of 14 days. Before and after balneotherapy/hydrotherapy, patients completed a questionnaire assessing their health, HAQ (Health Assessment Questionnaire) and a questionnaire on the quality of life of patients with rheumatoid arthritis, RA-QoL (Quality of Life RA). Disease activity score DAS 28 is used to measure the effects of the disease before and after balneotherapy/hydrotherapy. We found a significant improvement of functional capacity in patients with RA. Average HAQ before balneotherapy/hydrotherapy was 1.07 + / - 0.61 and 0.84 + / - 0.55, after balneotherapy/hydrotherapy, which was significantly lower (p <0.05). DAS 28 after balneotherapy/hydrotherapy is significantly lower than the DAS 28 before balneotherapy/hydrotherapy: mean DAS 28 before balneotherapy/hydrotherapy treatment was 6.30 + / - 0.81 and after balneotherapy/hydrotherapy 5.45 + / - 0 , 75 (p <0.01). Quality of life was significantly improved after balneotherapy/ hydrotherapy: mean QoL-RA before balneotherapy/hydrotherapy treatment was 5.38 + / - 1.62 and after balneotherapy/hydrotherapy 7.37 + / - 1.81 (p <0.05 ). In conclusion, balneotherapy/hydrotherapy, when properly dosed, is an effective therapy in the treatment of patients with RA. Balneotherapy/hydrotherapy has a positive effect on disease activity, functional ability and quality of life in patients with rheumatoid arthritis

Eccentric Exercises on the Board with 17-Degree Decline Are Equally Effective as Eccentric Exercises on the Standard 25-Degree Decline Board in the Treatment of Patellar Tendinopathy

Background and Objectives: Patellar tendinopathy is one of the most significant problems in jumping and running athletes. Eccentric quadriceps exercise has been introduced into the therapy of patients with patellar tendinopathy in order to avoid weakening the tendon during rehabilitation. The use of decline boards with a decline angle of 25° has been the cornerstone of therapy over the last two decades. Biomechanical studies have suggested that an equal or potentially better outcome could be achieved with lower angles of decline (up to 16°). Materials and Methods: In this present research, we compared the effects of two various decline board angles on the clinical outcome of patients treated for patellar tendinopathy by performing eccentric quadriceps exercises. Patients were randomly allocated into two groups: patients practicing on the standard board with a 25° decline, and patients practicing on the 17° decline (n = 35 per group). Results: After 6 weeks of exercise, we found a significant improvement in all the clinical scores (VISA-P score, KOOS score, Lysholm Knee Questionnaire/Tegner Activity Scale, and VAS scale) of treated patients. However, there was no significant difference between the patients who performed eccentric quadriceps exercises on the standard 25° decline board and those exercising on the 17° decline board. A smaller additional degree of improvement was visible at the end of the follow-up period (at 12 weeks), but, again, no statistical difference could be detected between the investigated groups. We conclude that both treatment options provide similar short-term and midterm benefits regarding improvements in pain and clinical scores. The improvement in clinical scores does not depend on age, sex, BMI, or the professional sport of the patient. Conclusions: Our findings encourage changes in the decline angle of the board in the case of a patient’s discomfort in order to achieve better compliance without affecting the recovery