РОЛЬ ВЕГЕТАТИВНОЙ НЕРВНОЙ СИСТЕМЫ В ГЕНЕЗЕ ПЕРВИЧНОЙ ХРОНИЧЕСКОЙ БОЛИ У ПОДРОСТКОВ ПО РЕЗУЛЬТАТАМ ВЫБОРОЧНОГО КРОСС-СЕКЦИОННОГО ИССЛЕДОВАНИЯ

Abstract

The “Chronic Pain” in children and adolescents is an expression that is currently not used widely in Russian pediatric practice. At the same time the clinical variants of Chronic Pain are widely used in practice and are often considered within the classification framework of autonomic dysfunction. The purpose of the study was to determine the possible influence of the autonomic nervous system (ANS) on the occurrence and course of Chronic Pain in male adolescents with recurrent headaches and abdominal pains as the example diagnoses; to value the various diagnostic criteria of ANS activity indicators for Chronic Pain; to demonstrate the doubtfulness of attributing these manifestations of Chronic Pain to ANS diseases. Materials and methods: the research work was carried out in February to May, 2013. A selective cross-sectional study was conducted among 14 to 18 years old male pupils of the cadet corps. The main group of patients consisted of adolescents with headaches and/or abdominal pains (n=90, average age 15.5 y/o, CI 15.2-15.8), whose clinical characteristics fully consistent with generally accepted international criteria for primary headaches and functional disorders occurring with abdominal pains. The comparison group (n=93, average age 15.6 y/o, CI 15.3-15.9) consisted of apparently healthy male adolescents. The VNS indicators were assessed using the A.M. Wayne questionnaire (the N.A. Belokon version) coupled with the cardiointervalography (CIG) data: the background ANS activity indicators as the baseline and the characteristics of the ANS reactivity. The CIG was performed in 111 (60.7%) patients who had sinus rhythm according to the ECG data. In the remaining 72 (39.3%) patients the ectopic atrial rhythm was detected which had prevented the evaluation of the CIG results. To assess the ANS activity characteristics with a masked method the ECG was registered and deciphered in 100% of patients; and the CIG in patients with the absence of cardiac arrhythmias. In addition, all of the participants (183) have undergone a clinical assessment of the initial autonomic tone using a questionnaire. Results: there were no statistically significant differences in the ANS activity between the two groups of patients: those with primary Chronic Pain and healthy individuals. There was therefore no significant diagnostic value found of the abovementioned characteristics according to the odds ratio criterion. The evidence of the VNS role in the genesis of the primary Chronic Pain was not registered. Conclusion: the conventional belief that headaches and abdominal pains are a manifestation of autonomic dysfunction had not been confirmed. The existing concept of ANS dysfunction with polymorphic clinical manifestations, including pain, has no proper justification and raises doubts about its appropriateness.