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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

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Diseases of the peripheral joints (osteoarthritis OA) and the spine are the most common pathology among other chronic conditions. One of the most common diseases characterized by degenerative periarticular changes with various clinical manifestations is periarthritis. Unlike OA, periarthritis is characterized by a discrepancy between active and passive movements, increased pain during strictly defined movements, the absence of joint swelling or local swelling in the projection of the affected tendon. As the basic therapy of OA (step 1), it is recommended to prescribe locally nonsteroidal anti-inflammatory drugs (NSAIDs), as drugs with less systemic adverse effects. Local NSAIDs have a sufficient analgesic effect in knee joints OA. Among topical NSAIDs for reducing pain in knee joints OA and periarticular tissues, diclofenac gel (Voltaren Emulgel 2%) is approved for use, the effectiveness of which has been demonstrated in many studies. To achieve maximum effect, the gel is applied according to the instructions for use of the drug: 2 ml on the anterior, posterior and lateral surfaces of the knee 2 times a day (every 12 hours) for 4 weeks.

Chronic pain continues to remain one of the urgent problems of modern medicine. From 15 to 25% of the adult population suffers from chronic pain. Medical treatment includes the appointment of non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants. The greatestform for the appointment of NSAIDs is the topical form. According to the recommendations of International and National societies for the treatment of pain syndrome, osteoarthritis (OA) therapy are recommended to start with topical NSAIDs, as drugs with less systemic adverse side effects (NSAIDs).Topical NSAIDs have proven analgesic and antiinflammatory efficacy in the treatment of diseases of the musculoskeletal system, musculoskeletal pain, but have a low risk of developing systemic NSAIDs in comparison with oral forms, which expands the possibilities of their appointment in patients with comorbid pathology (diseases of the gastrointestinal tract, cardiovascular risks).Among NSAIDs, diclofenac is the "gold standard" of analgesia. After topical application, diclofenac penetrates through the skin and further into the deeper underlying tissues while maintaining sufficient concentration to provide a therapeutic effect. The topical form of diclofenac – diclofenac diethylamine 2%, when used correctly, can cause an analgesic effect comparable to the oral form. This topical form has a high clinical efficacy in the treatment of acute musculoskeletal pain (sprains), the course of therapy takes 1 week, for chronic pain syndromes (knee OA or hand) the course of therapy is from 2 to less than 6 weeks. The clinical efficacy of diclofenac diethylamine monotherapy is comparable to that for complex therapy in combination with oral forms of NSAIDs, while having good tolerability.