Нейропатичний біль при анкілозивному спондиліті та особливості психопатологічного реагування

Abstract

The purpose of the work was to study the features of psychopathological symptoms in ankylosing spondylitis with and without neuropathic pain. Materials and methods. We clinically examined 142 patients treated between 2019 and 2022 who were diagnosed with ankylosing spondylitis according to the modified New York criteria. These patients were divided into two groups: the first group had the signs of neuropathic pain; the second group had no signs. The study of the psycho-emotional sphere was carried out using the The Zung Self-Rating Depression Scale, scales for assessing the level of personal and reactive anxiety by S. Spilberger, and the Mini Mental State Examination questionnaire was used to determine cognitive function. Results and discussion. It was found that the basis of psychopathological reactions in ankylosing spondylitis are mild and moderate depressive and anxiety symptoms: the average score on The Zung Self-Rating Depression Scale in patients without neuropathic pain was 48.1 ± 13.1 points, and in patients with neuropathic pain – 58.1 ± 4.6 points (p<0.01). 28.9% had no signs of depression, 45.1% showed signs of mild depression, and 26.0% – moderate depression. In 41.5% of patients without neuropathic pain, no signs of depression were found, in 40.4% – mild depression, in 18.1% – moderate, in patients with neuropathic pain – 4.2%, 54.2%, and 41.6%, respectively. The average value of the reactive anxiety index in the examined was 47.2 ± 12.2 points, in patients without neuropathic pain – 45.5 ± 12.7 points, in patients with neuropathic pain – 50.4 ± 10.5 points (p<0.05); personal anxiety indicator was 45.5 ± 10.1, 43.7 ± 10.6 and 49.0 ± 8.2 points, respectively (p<0.05). A low level of reactive anxiety in patients with neuropathic pain was found in 2.1%, without neuropathic pain – in 13.8% (p<0.05); medium – respectively in 31.3% versus 36.2% (p>0.05), high – respectively in 66.6% versus 50.0% (p<0.05). There were significantly more patients with low levels of personal anxiety among those who did not have neuropathic pain – 20.2% versus 6.3% (p<0.05), and with high levels – among patients with neuropathic pain: 56.2% versus 38.3% (p<0.05). The average value of the Mini Mental State Examination index in all patients was 27.46 ± 1.77 points; in patients with neuropathic pain – 26.29 ± 1.39 points, without neuropathic pain – 28.06 ± 1.64 points (p<0.01). Conclusion. Correlation analysis made it possible to establish the presence of significant correlations between expressiveness of neuropathic pain and depression and anxiety. Depressive and anxious manifestations in ankylosing spondylitis reflect psychopathological reactions to severe disease, pain and somatic discomfort, and personal anxiety as a stable personality characteristic, in ankylosing spondylitis patients primarily reflects the formation of patho-characteristic features as a result of long-term somatogenic influence. Cognitive impairment is probably mediated by depressive and anxiety symptoms and the influence of pain syndrome. The presence of a neuropathic component of the pain syndrome is a factor that aggravates the state of the psycho-emotional sphere, which justifies the feasibility of prescribing psychopharmacological therapy for ankylosing spondylitis