Efficacy and tolerability of injectable collagen-containing products in comparison to trimecaine in patients with acute lumbar spine pain (Study FUTURE-MD-Back Pain).

Low back pain (LBP) represents an important subgroup of vertebrogenic pain with estimated prevalence around 80 %. Locally acting injectable collagen for topical application has recently extended the limited range of treatment options. The aim of the study was to evaluate the efficacy and safety of injectable collagen in patients with LBP. Patients suffering from LBP (< three months) were enrolled. They were administered either collagen 4 ml or trimecaine 1 % 4 ml in the form of subcutaneous paravertebral injections into eight pre-specified points (0.5 ml per each point) in the following schedule: two administrations in the first and second week, one in the third week. The pain intensity, Thomayer distance, Oswestry disability index, Lasseque test, quality of life, consumption of rescue medication and safety were evaluated. Exertional and rest pain, evaluated by a visual analogue scale, gradually decreased in both groups. Both treatments showed a statistically significant improvement in mobility and quality of life. The consumption of paracetamol as a rescue medication was significantly lower in patients treated with collagen than in the group treated with trimecaine (p=0.048). The analgesic efficacy of locally acting injectable collagen, as well as an analgesic sparing effect when compared to local anesthetics were demonstrated.

Chronic Low Back Pain: Current Pharmacotherapeutic Therapies and a New Biological Approach.

Chronic low back pain (CLBP) syndrome represents one of the leading causes of long-term disability worldwide. The prevalence of CLBP has been rising significantly in relation to increasing average life expectancy. CLBP results from chronification of acute low back pain. There are many factors contributing to the CLBP crisis; common etiopathogenetic factors include e.g., functional blockage of intervertebral joints. The treatment of CLBP is complex. An important part of treatment consists of pain pharmacotherapy, for which several groups of drugs are used. The problem lies in the side effects of many of these traditionally used medications. Therefore, new and safer treatment methods are being sought. Innovative options for CLBP pharmacology include injections containing collagen, which can be combined with other traditionally used drugs, which helps reduce dosages and increase the overall safety of CLBP therapy.

[Relation between the blood coagulation status in hemodialyzed patients and arteriovenous fistula thrombosis--prospective study]. / Vztah mezi hemokoagulacním stavem hemodialyzovaných pacientu a trombózami arteriovenózní pístele--prospektivní studie.

BACKGROUND: In a number of haemodialyzed patients occlusion of arteriovenous fistulae for different reasons occurs. In these patients many haemocoagulation changes are described. The objective of the present work was to assess whether these occlusions are due to hypercoagulation. METHODS AND RESULTS: The investigation comprised 49 men and 32 women aged 49.3 +/- 9.3 years with renal insufficiency which had persisted for 28 +/- 17 months. Before the fistula was made, some parameters of haemocoagulation were examined. Depending whether within 6 months occlusion of the fistula occurred, the patients were divided into two groups. In a group of 18 patients with thrombosis of the fistula euglobulin fibrinolysis without stimulus (340 +/- 48 min.) was longer, also after veno-occlusion (199 +/- 50 min.), as compared with the group without thrombosis (277 +/- 38 and 121 +/- 27 min. resp.) and the level of the inhibitor of the plasminogen activator (PAI-1) differed: 3.3 +/- 0.6 i.u. as compared with 2.6 +/- 0.8 i.u. P < 0.001 in all three parameters. In the other parameters no significant differences were found (haematocrit, fibrinogen, F VII, AT III, protein C, number and aggregation of thrombocytes) al in all instances P > 0.05. The sum of hypercoagulation findings was higher in the first group (5.3 +/- 1.5) than in the second group (3.5 +/- 1.5, P < 0.001). CONCLUSIONS: The authors assume that apart from other factors thrombosis of the fistula is influenced also by the haemocoagulation status, in particular fibrinolytic parameters. The latter may be supported also by other hypercoagulation factors which alone are ineffective.

[The effect of the hemocoagulation status in hemodialyzed patients on the patency of arteriovenous fistulas]. / Vliv hemokoagulacního stavu hemodialyzovaných nemocných na pruchodnost arteriovenózních pístelí.

In a group of regularly haemodialyzed patients the authors examined 15 who suffered from repeated obliterations of subcutaneous a-v fistulae and compared the results with findings in 14 patients before the establishment of the first fistula which did not become obliterated for a period of six months. The group of patients with repeated obliterations had a significantly lower level of antithrombin III, a higher number of thrombocytes with an increased aggregation induced by low concentrations of adenosine diphosphate and adrenaline. The authors assume that investigation of coagulation mechanisms in frequent obliterations of subcutaneous a-v fistulae can help towards therapeutic prevention and as a model situation for the investigation of the development of thrombosis in general.