Reumatizam
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Low-back pain is a major health and social problem. The approach to patients with low-back pain is complex and multidisciplinary, and drugs take the important place. In this rewiev we discuss knowledge about the role of non-opioid analgetics, nonsteroidal anti-inflammatory drugs and weak opioids in the treatament of low-back pain.
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Randomized Controlled Trial
[Therapeutic ultrasound in chronic low back pain treatment].
The purpose was to determine the efficacy of therapeutic ultrasound in patients with chronic low back pain. Thirty-one patients, age 38-77, with low back pain lasting more than three months and the intensity of pain on visual analogue scale at least 50 mm, are randomly divided in two groups. Ultrasound is applied on the lumbar paravertebral muscle in 16 patients and in 15 patients the machine was not switched on. ⋯ The value of the modified Schober measure for the ultrasound group were 5,7+0,8 cm vs. 5,8+/-0,9 cm (p>0,05) and in the placebo group were 5,4+/-0,9 cm vs. 5,6+/-1,0 cm (p>0,05). There was no significant statistical difference between ultrasound and placebo group regarding the efficacy of the treatment (patients p>0,05, physicians p>0,05). Therapeutic ultrasound was effective in decreasing the pain intensity in this research, but showed no improvement regarding the functional ability of the lumbar spine in patients with chronic low back pain.
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After the withdrawall of rofecoxib from worldwide market, there is ongoing debate whether gastrointestinal safety of COX-2 inhibition compared to non-selective NSAID-s may come at the cost of increased cardiovascular events. In this paper the relevant data regarding mechanisms, effects and side effects of selected COX-2 inhibitors are presented. Possible class effect is disscused and proposed alternative therapies.
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To determine frequency of neuromusculoskeletal etiology of chest pain is performed. By means of a retrospective analysis and on the basis of the history of the patients' disease, data were collected after chest pain had been medically worked out. The causes to chest pain were in 82% of cardial etiology, in 9% of neuromusculoskeletal etiology, in 6% of gastrointestinal etiology and 3% others. ⋯ The task of a doctor is to accurately recognize serious disorders as possible causes to chest pain. However, the doctor must not make wrong diagnosis of potentially dangerous conditions thus causing unwanted psychological and economical consequences. In order to realize this, adequate diagnostic possibilities are necessary besides the knowledge about all possible causes to chest pain.
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Cyclooxygenase-II (cox-II) selective inhibitors and other non-steroidal anti-inflammatory drugs (NSAIDs) are indicated for pain and stiffness in inflammatory rheumatoid arthritis. Rofecoxib have been shown to be associated with a reduced incidence of gastric erosions on endoscopy compared to standard NSAIDs in patients with arthritis. ⋯ Onset of pain relief occurred within 45 minutes in single-dose studies of rofecoxib 50 mg in postoperative dental pain. Rofecoxib consistently demonstrated analgesic efficacy in a variety of moderate to severe pain models.