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2017 | 17 | 4 | 221–226
Article title

Raz jeszcze o leczeniu bólu receptorowego – czy warto łączyć diklofenak z witaminami grupy B?

Title variants
Once again on the treatment of nociceptive pain – is it worth to combine diclofenac with B vitamins?
Languages of publication
Bóle kręgosłupa są częstą dolegliwością o  złożonej patofizjologii. Wytyczne dotyczące leczenia oscylują między postępowaniem fizjoterapeutycznym, farmakoterapią a leczeniem operacyjnym. Wydaje się, że każdy pacjent wymaga indywidualnego podejścia, co jest szczególnie ważne w  przypadku chorych w  starszym wieku  – ze względu na wielochorobowość i politerapię. Artykuł przedstawia korzyści i ograniczenia terapii diklofenakiem i witaminami grupy B w  leczeniu bólu, głównie o  charakterze kostno-stawowym. Diklofenak należy do grupy niesteroidowych leków przeciwbólowych i przeciwzapalnych. Cechuje się wysoką skutecznością terapeutyczną w zakresie bólu receptorowego, ale wywołuje także istotne działania niepożądane, w tym nadciśnienie tętnicze. Działanie przeciwbólowe witamin grupy B nie jest do końca wyjaśnione; wydaje się, że mogą one wpływać na zwiększenie ośrodkowej sekrecji serotoniny, regulować przewodnictwo dośrodkowe w zakresie rdzenia kręgowego lub – jak wskazują niektórzy, bardziej optymistyczni autorzy – wzmagać uwalnianie endogennych opioidów. W artykule zawarte są informacje na temat łączenia obu leków w kontekście skuteczności i bezpieczeństwa leczenia bólu receptorowego.
Spine pain is a  frequent ailment with a  complex pathophysiology. The guidelines for treatment oscillate between physiotherapeutic procedure, pharmacotherapy and surgical treatment. It seems that every patient requires an individual approach which is especially important in case of elderly patients – due to multiple morbidities and polytherapy. The article presents the benefits and the limitations of the therapy applying diclofenac and B vitamins in the treatment of pain, mainly osteo-articular pain. Diclofenac belongs to the group of non-steroidal analgesic and anti-inflammatory drugs. It demonstrates high therapeutic efficacy in the scope of nociceptive pain, however, it also causes significant adverse effects including arterial hypertension. The analgesic effect of group B vitamins has not been fully explained; it seems that they may affect the increase of the secretion of serotonin in the central nervous system, regulate afferent conduction in the scope of the spinal cord or – as indicated by some, more optimistic, authors – enhance the release of endogenous opioids. The article includes information referring to combining both drugs in the context of the efficacy and safety of treating nociceptive pain.
Physical description
  • Zakład Farmakokinetyki iTerapii Monitorowanej, Katedra Farmakologii, Pomorski Uniwersytet Medyczny w Szczecinie, Szczecin, Polska
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