INFLUENCE OF DULOXETINE ON THE CLINICAL COURSE AND BIOCHEMICAL PARAMETERS IN PATIENTS WITH CHRONIC VERTEBROGENIC LUMBOSACRAL PAIN SYNDROMES

Authors

  • A. R. Kulyk DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY
  • A. V. Paienok DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY
  • L. D. Soika ANDREI KRUPYNSKY LVIV MEDICAL ACADEMY
  • L. E. Lapovets DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY
  • N. D. Boikiv DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY
  • S. O. Tkachuk DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY
  • N. Z. Lutsiv DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY
  • N. R. Demianchuk DANYLO HALYTSKYI LVIV NATIONAL MEDICAL UNIVERSITY

DOI:

https://doi.org/10.11603/mcch.2410-681X.2023.i3.14128

Keywords:

chronic lumbosacral pain syndromes, duloxetine, substance P, cortisol

Abstract

Introduction. Chronic lower back pain is a source of suffering for millions of individuals and a leading cause of disability in developed countries. Unfortunately, there is currently no consensus on the pathogenesis of chronic pain, and a standardized, sequential approach to treatment remains elusive. The development of chronic pain is a complex and multifaceted process influenced by various factors. This article analyzes the clinical course of pain syndrome, assesses levels of depression, anxiety, and quality of life, and evaluates levels of substance P and cortisol in the blood among patients undergoing duloxetine treatment

The aim of the study – to assess the impact of duloxetine on the clinical course and biochemical parameters in patients with chronic vertebrogenic lumbosacral pain syndromes (VLSPS) following comprehensive inpatient treatment.

Research Methods. A comprehensive clinical examination and determination of biochemical markers (cortisol and substance P) in serum were conducted in 45 patients (average age 41.2±11.2 years, 26 males (57.7 %), 19 females (42.3 %)). Biochemical markers were determined using the enzyme-linked immunosorbent assay method without extraction in serum samples.

Results and Discussion. After 8 weeks of daily administration of duloxetine at a dose of 60 mg in patients with chronic VLSPS, the severity of pain syndrome decreased, and the likelihood of clinical symptoms (muscle tension, antalgic scoliosis, Lasegue's sign) significantly decreased (p<0.05). The mobility of the lumbar spine improved according to the finger-to-floor test results, from (23.12±2.31) cm to (16.46±2.26) cm. Anxiety and depression scores decreased significantly, and quality of life improved (p<0.05). The level of substance P in the blood decreased from (8.25±2.35) ng/ml to (6.11±2.71) ng/ml, while cortisol levels decreased from (379.3±93.1) nmol/L to (212.2±88.0) nmol/L (p>0.05).

Conclusions. Prescribing duloxetine after completing inpatient treatment in patients with chronic VLSPS leads to improvements in clinical metrics, as well as a reduction in cortisol and substance P levels in the blood.

References

Epidemiology of low back pain in adults. Neuro-modulation : journal of the International Neuromodulation Society, 17 Suppl 2, 3-10. DOI: https://doi.org/10.1111/ner.12018

Kahere, M., Hlongwa, M., & Ginindza, T.G. (2022). A Scoping Review on the Epidemiology of Chronic Low Back Pain among Adults in Sub-Saharan Africa. Inter­national Journal of Environmental Research and Public Health, 19 (5), 2964. DOI: https://doi.org/10.3390/ijerph19052964

Kos, N., Gradisnik, L., & Velnar, T. (2019). A Brief Review of the Degenerative Intervertebral Disc Disease. Medical archives (Sarajevo, Bosnia and Herzegovina), 73 (6), 421-424. DOI: https://doi.org/10.5455/medarh.2019.73.421-424

Hoy, D., Brooks, P., Blyth, F., & Buchbinder, R. (2010). The Epidemiology of low back pain. Best practice & research. Clinical Rheumatology, 24 (6), 769-781. DOI: https://doi.org/10.1016/j.berh.2010.10.002

Povoroznyuk, V.V., & Shinkarenko, T.E. (2017). A modern perspective on the diagnosis of lower back pain. Problems of Osteology, (20, No. 1), 31-43 [in Ukrainian].

Dionne C. E. (2005). Psychological distress con­firmed as predictor of long-term back-related functional limitations in primary care settings. Journal of Clinical Epidemiology, 58 (7), 714-718. DOI: https://doi.org/10.1016/j.jclinepi.2004.12.005

Avramenko, O.M., & Haustova, O.O. (2015). Painful behavior in patients with chronic pain syndrome. Archives of Psychiatry, (21, No. 1), 63-67 [in Ukrainian].

Zgurskyi, A., Zakablutskyi, Ya., & Fedorenko, S. (2021). Analysis of the influence of psychosocial factors on the result of physiotherapeutic intervention for pain in the lower back. Sports Medicine, Physical Therapy and Occupational Therapy, (2), 106-109 [in Ukrainian].

Fillingim R.B. (2017). Individual differences in pain: understanding the mosaic that makes pain personal. Pain, 158 Suppl 1(Suppl 1), S11-S18. DOI: https://doi.org/10.1097/j.pain.0000000000000775

Cohen, S.P., Vase, L., & Hooten, W.M. (2021). Chronic pain: an update on burden, best practices, and new advances. Lancet (London, England), 397 (10289), 2082-2097. DOI: https://doi.org/10.1016/S0140-6736(21)00393-7

Neurogenic inflammation as a novel treatment target for chronic pain syndromes. Experimental Neurology, 356, 114108. DOI: https://doi.org/10.1016/j.expneurol.2022.114108

Glombiewski, J.A., Hartwich-Tersek, J., & Rief, W. (2010). Attrition in cognitive-behavioral treatment of chronic back pain. The Clinical Journal of Pain, 26(7), 593-601. DOI: https://doi.org/10.1097/AJP.0b013e3181e37611

Kamper, S.J., Apeldoorn, A.T., Chiarotto, A., Smeets, R. J., Ostelo, R.W., Guzman, J., & van Tulder, M.W. (2015). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ (Clinical research ed.), 350, h444. DOI: https://doi.org/10.1136/bmj.h444

Cawston, H., Davie, A., Paget, M.A., Skljarev­ski, V., & Happich, M. (2013). Efficacy of duloxetine versus alternative oral therapies: an indirect comparison of randomised clinical trials in chronic low back pain. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 22 (9), 1996-2009. DOI: https://doi.org/10.1007/s00586-013-2804-7

Pergolizzi, J.V., Jr, Raffa, R.B., Taylor, R., Jr, Rodriguez, G., Nalamachu, S., & Langley, P. (2013). A review of duloxetine 60 mg once-daily dosing for the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis pain and low back pain. Pain practice: the official journal of World Institute of Pain, 13 (3), 239-252 DOI: https://doi.org/10.1111/j.1533-2500.2012.00578.x

Weng, C., Xu, J., Wang, Q., Lu, W., & Liu, Z. (2020). Efficacy and safety of duloxetine in osteoarthritis or chronic low back pain: a Systematic review and meta-analysis. Osteoarthritis and Cartilage, 28 (6), 721-734. DOI: https://doi.org/10.1016/j.joca.2020.03.001

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Published

2023-10-27

How to Cite

Kulyk, A. R., Paienok, A. V., Soika, L. D., Lapovets, L. E., Boikiv, N. D., Tkachuk, S. O., … Demianchuk, N. R. (2023). INFLUENCE OF DULOXETINE ON THE CLINICAL COURSE AND BIOCHEMICAL PARAMETERS IN PATIENTS WITH CHRONIC VERTEBROGENIC LUMBOSACRAL PAIN SYNDROMES. Medical and Clinical Chemistry, (3), 30–35. https://doi.org/10.11603/mcch.2410-681X.2023.i3.14128

Issue

No. 3 (2023)

Section

ORIGINAL INVESTIGATIONS

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