Pharmacotherapy of pain in musculoskeletal diseases: evolution and revolution of views

The article presents new views on the treatment of pain syndromes in musculoskeletal diseases, in particular in osteoarthritis (OA) of various localizations (gonarthrosis, coxarthrosis). New recommendations (2019–2020) of international societies for the study of symptomatic delayedacting drugs (SYSADOA) and their use in the treatment of OA are presented. We present the opinions of experts from different communities: the American College of Rheumatology (ACR, 2019), the European Alliance of Associations for Rheumatology (EULAR, 2019), the European Society for the Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO, 2020) – on the prescription of SYSADOA, which include chondroitin sulfate (CS), glucosamine sulfate (GS), avocado and soy unsaponifiable compounds, diacerein, hyaluronic acid for intraarticular administration. New domestic clinical guidelines (2020–2021) for the treatment of OA are presented. The changes that have taken place in the terminology of pain and in the classification of pain syndromes, reflected in the new International Classification of Diseases of the 11th revision (ICD-11), are analyzed. New approaches to the stratification of OA, taking into account endo- and phenotyping, as well as new aspects in pain therapy associated with the molecular genetic mechanisms of SYSADOA are shown. According to the EULAR recommendations, there is indisputable evidence of the efficacy and safety of pharmaceutical CS, which is reflected in a meta-analysis (2019), a randomized placebo-controlled trial (2019), approved by the Russian Ministry of Health, and confirmed in Chondroguard’s meta-analysis of clinical trials (2020). New approaches in the treatment of pain syndromes provide for parenteral administration of CS and GS according to an intermittent scheme. The search and development of new molecules comparable in efficacy to SYSADOA in the treatment of pain in OA and low back pain have led to the emergence in clinical practice of biologically active compositions, including undenatured type II collagen, the effectiveness of which is associated with a neuroimmune mechanism of action.