Severity Of Pain Syndrome Research Articles

Gradation of the severity of myofascial pain syndrome of the masticatory muscles

Relevance. Due to the high prevalence of myofascial pain syndrome of the masticatory muscles, the issue of treatment of this pathology remains relevant. Due to the heterogeneity of the severity of clinical manifestations, these additional examination methods, the development of a treatment plan by a dentist causes certain difficulties. Materials and methods. Based on the data of a clinical and functional examination of 102 people aged 18 to 35 years, a gradation of the severity of MBS of the masticatory muscles was developed. In a clinical study, the presence and severity of pain during palpation, the degree of mouth opening, and an assessment of functional activity on the MAS scale were determined. Ultrasound examination was used to study the indicators of the area and thickness of the cross-section of the chewing muscles, visualization and size of trigger points. According to the electromyographic study, a comparative analysis of the average amplitude of the masticatory muscle, the total biopotential, and an assessment of the symmetry of the masticatory muscles was carried out. Results. The data obtained made it possible to develop a gradation of the severity of MBS by 3 degrees, depending on the indicators (mild, moderate, high). Conclusion. The development of this graduation will allow for an individual patient-oriented approach to the treatment of this category of people, which will contribute to improving the quality of medical care at a dental appointment

Pharmacogenetic features of tramadol metabolism affecting the quality of postoperative analgesia in vascular surgery

BACKGROUND: The issue of the efficacy and safety of medications employed for postoperative analgesia has not been resolved to date. Insufficient analgesia constitutes one of the primary risk factors for developing cardiovascular complications postoperatively. Tramadol is a medication that is frequently used for postoperative pain relief following minor and moderately traumatic operations. The biotransformation of this drug is considerably slowed by the presence of CYP2D6 gene polymorphisms G1846A and C100T, which play a significant role in its metabolism. In such patients, a decrease in the quality of postoperative analgesia can be anticipated, which will consequently lead to an increase in cardiac complications. AIM: To assess the efficacy of a postoperative analgesia regimen based on tramadol and the incidence of cardiac complications during vascular operations depending on the presence/absence of polymorphisms of the CYP2D6 gene polymorphisms, an isoenzyme of cytochrome P-450. MATERIALS AND METHODS: An examination of 109 patients undergoing planned vascular surgery was conducted. The frequency of occurrence of polymorphisms G1846A and C100T of the CYP2D6 gene was determined. All patients were assessed for the severity of postoperative pain syndrome during activity and at rest using a visual analog scale on the first day following surgery. Cardiovascular complications that arose while the patients were in the hospital were documented. To assess the autonomic nervous system, patients underwent cardiointervalography. RESULTS: Polymorphism G1846A was detected in 28 (25.7%), while C100T was detected in four (3.7%) patients. Patients without polymorphisms were included in group 1 (n=77). Patients with polymorphisms were assigned to group 2 (n=32). Pain syndrome at rest and during activity was higher in group 2 patients (p 0.05). The tension index before surgery did not differ between the groups; however, it was greater in group 2 patients after surgery (p 0.001). Cardiac complications were identified in 9.1% of group 1 and 18.8% of group 2 patients (p=0.20). CONCLUSION: The frequency of polymorphisms G1846A and C100T of the CYP2D6 gene in patients who underwent vascular surgery was 29.4%. Such patients experienced pain syndrome of greater severity. The patient groups did not exhibit any significant differences in the frequency of cardiac complications.

Severity of pain syndrome, functional activity, and quality of life in male patients with inguinal hernias in the preoperative period

According to the European Hernia Society (EHS) and the Hernia Surge Group (HSG), males with inguinal pain syndrome make up the majority of candidates for planned inguinal hernia surgeries. Chronic groin pain in the preoperative stage typically has a negative impact on such patients’ functional activity and quality of life. It is therefore considered a significant indication for planned surgery. According to recent research, appropriate functional outcomes, such as improved physical activity and patient quality of life, are as important as an accurate anatomical restoration of the inguinal region after planned inguinal hernia surgery. Objective — to assess the severity of preoperative inguinal pain syndrome, functional activity, and quality of life in male patients with inguinal hernias. Materials and methods. The study focuses on the preoperative clinical examination of 50 patients (males) with primary unilateral inguinal hernias. The patients were treated in the surgical department of the State Scientific Institution «Centre for Innovative Medical Technologies of the National Academy of Sciences of Ukraine» between 2018 and 2024. A questionnaire method was employed to assess the functional activity, quality of life, and severity of pain syndrome in patients before surgery. This method involved the use of the modified Carolinas Comfort Scale (MCCS), the European Questionnaire for the Assessment of Quality of Life (EQ‑5D‑3L), and the Visual Analogue Scale (VAS). Results. The average pain severity index on the VAS was 2.1±0.9 points. The MCCS was used to assess patients’ functional activity, resulting in an average total score of 33.7±12.1 points, which corresponded to 44.9%, classifying the patients as «not satisfied» in the clinical group. The EQ‑5D‑3L descriptive system was used to assess patients’ quality of life. We found that 30% reported moderate mobility limitations, 18% reported moderate self‑care issues, and 34% reported limitations in their daily activities. 24% of patients exhibited moderate anxiety or depression‑related symptoms. At the same time, all patients noted the presence of pain syndrome, with 76% experiencing moderate pain and 24% suffering severe pain. Conclusions. The «symptomatic» group of males with inguinal hernias exhibits a high level of local pain syndrome in the area of the hernia protrusion (2.1±0.9 on the VAS, and 24 % of patients reported a significant degree of pain severity before planned surgical intervention (> 3 points) according to the EQ‑5D‑3L system). In the vast majority of cases, it significantly impairs their functional activity and quality of life (66% of patients are not satisfied with their quality of life (32.4±5.6 points on the MCCS)). Effective local pain management is an important objective in the planned surgical treatment of inguinal hernias. This necessitates further investigation into surgical technique selection and procedure adjustments.

Ретроспективный сравнительный анализ эффективности хондропротективной терапии пациентов с хронической болью в нижней части спины

INTRODUCTION. The choice of optimal therapy for chronic lower back pain includes: influence on all links of the pain vicious circle, has analgesic and anti-inflammatory effects, chondroprotective effect. AIM. A retrospective comparative analysis of outpatient records of patients with chronic lower back pain with a course of therapy with drugs containing chondroitin sulfate – Chondroguard, and bioactive concentrate of small marine fish – Alflutop. MATERIAL AND METHODS. Outpatient records of patients who took Chondroguard and Alflutop in the period from January 2022 to April 2024 were included. Data from 60 patients (medium age 51.5±9.7 years). Patients were retrospectively divided into two groups depending on the strategy of pain management. The main group (n=30; medium age 51.0±9.8 years), who received Chondroguard intramuscularly (I/ m) every other day No. 25 according to the scheme: the first 3 injections (1st, 3rd, 5th day) - 1 ml (100 mg), with good tolerability from the 4th injection (7 day) – 2 ml (200 mg); and the Comparison group (n=30; medium age 49.3±9.9 years), received Alflutop 2 ml, 1 time a day, every other day, a short course of 10 days. The dynamics of the condition was assessed on days 10, 20, 50. RESULTS AND DISCUSSION. By day 50 in the Main group, there was a decrease in pain by an average of 86.6% according to the numerical rating scale and an improvement in the functional status according to the Oswestry scale of 95.5%, in the comparison group there was a decrease in pain by an average of 77.2%, an improvement in the functional status according to Oswestry scale of 86.7%. By day 50, the severity of pain syndrome in the Main group decreased by 91.2%, in the Comparison group – by 33.9%; indicators of the functional status of Oswestry scale in the Main group improved by 97.3%, in the Comparison group – by 84.8%. In the Main group, the need for multiple nonsteroidal anti-inflammatory drugs on the 10th day of therapy decreased to 1 tablet per day in 76.7%, in the Comparison group – in 16.7%. In the main group, after a course of therapy for 21.3±2.2 months. they did not consult a doctor in the comparison group after 5.3±1.1 months. A second course of therapy was conducted. CONCLUSION. In the Main group, the effects of therapy can be regarded as long-term, since the effects of highly purified chondroitin sulfate on the pathogenetic mechanisms of the formation of chronic lower back pain remain. KEYWORDS: pain syndrome, lower back pain, chondroitin sulfate, Chondroguard

The severity of pelvic pain syndrome associated with external genital endometriosis in women of reproductive age as a prognostic factor for the degree of prevalence of the process

The severity of pain in patients with external genital endometriosis (EGE) associated with pelvic pain syndrome was assessed using a visual analogue scale (VAS) and the McGill pain questionnaire, and the effectiveness of surgical treatment of patients with EGE was assessed. Predicting the IV and I degrees of endometriosis prevalence will allow the obstetrician-gynecologist to choose treatment tactics for patients, diagnose and the ability to prevent the progression of the disease in the early stages.

Боль в спине. Результаты неинтервенционного исследования применения препарата Амбениум® парентерал в условиях реальной клинической практики

Aim: to estimate efficacy, tolerability, and safety of Ambenium® parenteral [phenylbutazone sodium 400 mg and lidocaine hydrochloride 4 mg] used for treatment of patients with low back pain. Methods. A total of 100 patients with low back pain (LBP), who received a single intramuscular injection of Ambenium® parenteral, were included in the study. The follow-up period was 3 days. The change in pain severity on VAS (mm) was selected as a primary outcome measure for efficacy. The pain syndrome severity was estimated before administration of the drug (visit 1) and 4, 6, 8 and 12 h after the drug administration, as well as during visits 2 (day 2) and 3 (day 4). The McGill Pain Questionnaire, muscle syndrome index (MSI), Roland-Morris Disability Questionnaire pain estimates were used as the secondary diagnostic criteria. The percentage of patients with the positive response relative to baseline (the decrease in pain severity on VAS by more than 50%) was also determined. Results. The dynamics of the primary efficacy measure (pain severity on VAS) was as follows: 7.4 ± 0.92 cm (mean ± standard deviation) during visit 1, 5.6 ± 1.49 cm after 2 h, 4.6 ± 1.74 cm after 4 h, 3.0 ± 1.79 cm after 8 h; the VAS score was 2.3 ± 1.70 cm after 12 h (р<0.001). The share of patients who responded to therapy (with the decrease in pain severity on VAS by more than 50% relative to baseline) was 84% [95% CI: 75.0 – 91.0] 24 h after the first administration, 94% during visit 3 [95% CI: 87.0 – 98.0], р<0.001. The secondary efficacy criteria (muscle syndrome index and McGill Pain Questionnaire score) showed significant positive dynamics (р<0.001). No systemic adverse events were reported. Conclusion. The study showed that a single intramuscular injection of Ambenium® parenteral was an efficient, well-tolerated and safe treatment option for low back pain. Administration of a single drug dose makes it possible to ensure a significant clinical effect reflected in the pain severity decrease and restoration of the patient’s motor activity.

Association Between Knee Pain and Patellofemoral Syndrome (PFS) In Football Players

Background: Knee pain and patellofemoral syndrome (PFS) are common among athletes, particularly in sports requiring extensive lower limb use such as football. These conditions can significantly impair performance and quality of life. Objective: This study aimed to investigate the prevalence and severity of knee pain and patellofemoral syndrome among football players, and to explore the association between these conditions. Methods: The study was conducted with 145 football players who provided informed consent, in alignment with the Declaration of Helsinki. Data were collected using structured surveys that included the Numeric Pain Rating Scale and the Kujala Scoring questionnaire. The analysis utilized SPSS software (version 25) to conduct descriptive and inferential statistics. Qualitative data were assessed by frequencies and percentages, while quantitative data analysis involved computing means and standard deviations. The association between knee pain and PFS was examined using a Pearson Chi-Square test. Results: The average age of participants was 22.95 years (SD = 2.83), ranging from 19 to 28 years. Regarding knee pain, 8.3% reported no pain, 26.2% mild pain, 32.4% moderate pain, and 33.1% severe pain. For PFS symptoms, 10.3% of players had no symptoms, 27.6% mild, 31.7% moderate, and 30.3% severe symptoms. The Pearson Chi-Square test yielded a p-value of less than 0.05, indicating a significant association between knee pain and the presence of PFS. Conclusion: The study confirmed a significant correlation between knee pain and PFS among football players, highlighting the need for targeted preventive and therapeutic strategies in sports settings to enhance player health and performance.

Evaluation of the effectiveness and safety of erector spinae plane block during coronary artery bypass surgery: a randomized clinical trial

The search for a method of perioperative pain control after coronary bypass surgery is relevant both from the point of view of safety and effectiveness of the methods used.Aim: To evaluate the hemodynamic changes and effectiveness of erector spinae plane block (ESPB) for off-pump coronary artery bypass surgery.Methodology and research methods. The prospective randomized single-center study included 45 patients equally distributed according to the applied methods of perioperative analgesia into 3 groups: general anesthesia with epidural anesthesia (GA + EA group, n = 15), general anesthesia with ESPB (GA + ESPB group, n = 15) and general anesthesia without any regional anesthesia techniques (GA group, n = 15). Assessment of hemodynamics and severity of pain syndrome was performed during the first postoperative day.Results. The intraoperative dose of fentanyl was 0.4 (0.4–0.5) mg in the GA + EA group, and 0.4 (0.3–0.4) mg in the GA + ESPB group that is significantly less than in the GA group – 1.1 (1.0–1.1) mg (p < 0.001). Postoperatively, the dose of fentanyl was 0.10±0.04 mg in the GA + EA group and 0.23±0.05 mg in the GA group (p < 0.001), whereas in the ESPB group fentanyl was not used. The pain level assessed by the numeric rating scale (NRS) was 3.0 (2.0–4.0) points at one hour after tracheal extubation and 3.0 (0.5–3.5) points at the end of the first day of the postoperative period without difference between the groups. The systemic and pulmonary hemodynamics, respiratory and vasopressor support did not differ as well.Conclusion. The use of regional anesthesia (EA and ESPB) provides similar quality of perioperative analgesia like general anesthesia, but leads to reduction in opioid doses. Postoperatively, the use of ESPB does not lead to a deterioration of the hemodynamic status of the patient.

Gut microbiota – a new link in the pathogenesis of osteoarthritis (literature review)

The intestinal microbiota (IMB) can indirectly affect the course of ostearthritis (OA) at the systemic level by stimulating a chronic nonspecific inflammatory reaction in the synovial membrane and subchondral bone, the cause of which is an increase in the amount of circulating lipopolysaccharides (LPS) of the bacterial wall, as well as provoke the development of metabolic syndrome, which links the two necessary components of the pathogenesis of OA. The result of direct exposure is the formation of leaky gut syndrome with the activation of LPS of the bacterial wall of mild inflammation, provoking the production of proinflammatory cytokines, the effect of which on synoviocytes and chondrocytes leads to their activation with subsequent production of IL-6 and IL-8, which contributes to the persistence of inflammation. By correlation analysis, the relationship of three taxa with OA joint damage was proved, namely, the order Desulfovibrionales and the genus Ruminiclostridium 5 – with knee joint OA, Methanobacteriaceae – with knee joint OA, and OA of any localization, and the appearance and degree of contamination with the genus Streptococcus correlated with the severity of pain syndrome. The metabolic syndrome itself can provoke the development of dysbiosis, so it can also be its consequence. A change in the composition of the microbiota in the form of the predominance of the genus Clostridium and the species Staphylococcus aureus with a decrease in the diversity of microorganisms is associated with an increase in the amount of adipose tissue in the body, dyslipidemia, insulin resistance with impaired carbohydrate metabolism. Low levels of LPS in the blood are found in obese patients even in the absence of an obvious focus of infection due to violations in the CMB, they signal TLR-4, triggering systemic inflammation. Studies have shown a positive effect of prescribing proand prebiotics on the course of OA, which makes IMB a promising target for the treatment and prevention of OA.

Modulation of microRNA-133B in Post Mastectomy Pain Syndrome Following Yoga Intervention

Objectives: This study aimed to compare the efficacy of yoga combined with an integrated multimodal approach on the incidence and severity of post-mastectomy pain syndrome (PMPS) and the role of miR-133B expressions in patients undergoing breast cancer surgery. Methods: With approval from the institutional ethics committee and informed consent obtained from each participant, forty patients of ASA grade I - II, aged 20 - 65 years, undergoing breast cancer surgery were included. Patients received a thoracic paravertebral block for up to 72 hours and pregabalin until the end of the fourth postoperative week. Patients were randomly allocated into two groups: “Control” and “yoga.” Patients in the Yoga group practiced the yogic exercise “Anulom-vilom" from the third day until the 90th day postoperatively. The delta-CT of miRNA-133B expression of genes on the 90th postoperative day was compared to the baseline, along with various pain intensity and quality of life parameters. Results: In the Yoga group, a significant up-regulation in miR-133B expression was observed on days 30 and 90 postoperatively. Patients with PMPS in the Yoga group showed a decreased ΔCT of miR-133B, indicating an up-regulation of gene expression, compared to the control group. A lower incidence of PMPS (10% vs. 30%) was observed in the experimental group, along with a significant enhancement of quality of life in post-mastectomy patients and decreased mean Visual Analogue Scale (VAS) pain scores, Pain Detect Questionnaire (PDQ) ، and Neuropathic Pain Symptom Inventory (NPSI) scores in the Yoga group; however, these were not statistically significant. Conclusions: The study demonstrated the feasibility of integrating yoga with a multimodal pain management approach and highlighted the role of miR-133B in the pathogenesis of PMPS.

Influence of the volume of surgical intervention on the severity of pain in patients after orthognathic surgery

BACKGROUND: The treatment of patients with jaw abnormalities involves orthognathic surgery, a consequence of which is postoperative pain. Considerable research is allocated to the study of pain and its management because pain affects the comfort of patients during rehabilitation. Currently, the factors that are responsible for the severity of postoperative pain syndrome remains debatable. Additionally, before surgical treatment, patients are concerned about the intensity of postoperative pain and its relationship with the extent of surgery. Owing to existing disagreements, primarily regarding the relationship between the volume of surgical intervention and the intensity of pain, conducting this study is critical.
 AIM: To identify factors that directly influence postoperative pain experienced by patients.
 MATERIALS AND METHODS: Pain intensity in patients on day 2 following orthognathic surgery was measured using visual analog scale (VAS).
 RESULTS: During the study, patients after orthognathic surgery were divided into groups based on the extent of surgery, sex, age, and duration of surgery to compare their VAS pain intensity scores. No significant difference was found in the average VAS scores of patients’ pain intensity (p 0.05) between the groups.
 CONCLUSION: The volume and duration of orthognathic surgery, age, and sex of the patients did not affect the intensity of pain.

Non-pharmacological methods of treating chronic non-specific neck pain, possibilities of radiofrequency denervation: A review

Chronic non-specific neck pain (CNSNP), or cervicodynia, is a common pathology that significantly reduces the quality of life of patients. It is believed to be based on degenerative and dystrophic changes in the spine, as well as myofascial pain syndrome. Currently, a comprehensive approach is used in the treatment of CNSNP, including kinesitherapy, ergotherapy, manual therapy, and cognitive-behavioral therapy. In case of ineffectiveness of conservative patient management methods, radiofrequency denervation is used, which is an effective and safe procedure for reducing the severity of pain syndrome. The results of the use of radiofrequency denervation in CNSNP are discussed.

ХРОНИЧЕСКИЕ БОЛЕВЫЕ СИНДРОМЫ В СТАРЧЕСКОМ ВОЗРАСТЕ И РОЛЬ СУБСТАНЦИИ Р. ПРИ ДАННОЙ ПАТОЛОГИИ

ABSTRACT AIM. To investigate chronic pain syndromes in old age and evaluate the clinical significance of substance P in this pathology. MATERIAL AND METHODS. The study enrolled 68 patients over the age of 75 years with the presence of musculoskeletal pain of any origin for at least 3 months. The mean age of the patients reached 81.9 ± 5.8 years (from 75 to 100 years), most of them were women (85.3%). In this study, the severity of pain was assessed using a visual analogue scale (VAS), and the type of pain was analyzed using questionnaires and scales: DN4, PainDetect, Fibromyalgia Identification Questionnaire (FIRST), Central Sensitization Questionnaire, McGill Pain Questionnaire. The blood concentration of substance P was determined by enzyme immunoassay. RESULTS AND DISCUSSION. The severity of pain syndrome on the VAS scale reached 6.3 ± 2.2 points. The mean scores for DN4 were 3.9 ± 2.1 points, and for PainDetect — 14.7 ± 9.4 points. The mean value of the FIRST questionnaire for diagnosing fibromyalgia was 3.5 ± 1.6 points, and the McGill questionnaire was 69.8 ± 43.7 points. The mean value of the central sensitization scale reached 44.3 ± 16.7 points. Pain syndrome was more severe in women: the mean VAS value in women was 6.4 ± 2.3, in men — 5.1 ± 1.2 points (p = 0.02). The severity of the neuropathic component of the pain syndrome in women was also higher: DN4 scores in women were 4.0 ± 2.1, and in men — 2.9 ± 1.7 points (p = 0.08), and PainDetect — 15.7 ± 9.4 and 8.6 ± 6.4 points, respectively (p = 0.02). The mean values of the screening questionnaire for diagnosing fibromyalgia in women reached 3.7 ± 1.5 points, and in men — 2.7 ± 1.5 points (p = 0.07). In the group of women, the mean McGill questionnaire scores were 74.2 ± 45.2, in men — 45.3 ± 23.6 points (p = 0.006). The mean values of the central sensitization questionnaire for women were: 46.1 ± 16.3, and for men — 34.2 ± 15.5 points (p = 0.03). However, no significant differences in the severity of depression were recorded in women and men: 6.2 ± 2.8 and 5.0 ± 3.4 points, respectively (p = 0.3). The mean concentration of substance P in the study group was 222.6 ± 92.9 pg/ml, varying from 74 to 529 pg/ml. In men, the mean blood concentration of substance P reached 267.1 ± 85.2 pg/ml, in women — 214.2 ± 92.7 pg/ml (p = 0.02). An inverse correlation was registered between the blood concentration of substance P and the age of patients (r = −0.31; p = 0.02). No significant relationships were found between the blood concentration of substance P and the values of all pain questionnaires. Significant correlations were registered between VAS and DN4 (r = 0.29; p = 0.01), PainDetect (r = 0.41; p = 0.004), McGill questionnaire (r = 0.53; p < 0.0001) and central sensitization questionnaire (r = 0.3; p = 0.01). There was no significant correlation between the severity of pain according to VAS and the severity of depression (r = 0.16; p = 0.21). The severity of depression correlated with indicators of DN4 (r = 0.31; p = 0.01), FIRST (r = 0.26; p = 0.03), McGill questionnaire (r = 0.29; p = 0.02) and central sensitization questionnaire (r = 0.5; p < 0.0001). There was a direct correlation between the age of patients and indicators of DN 4 (r = 0.24; p = 0.05) and the central sensitization questionnaire (r = 0.25; p = 0.04). CONCLUSION. The study results suggest the presence of severe chronic pain syndrome of various types in old patients and longlivers. Significant relationships were found between pain indicators assessed using different scales and questionnaires. In this study, no significant correlations were established between the blood concentration of substance P and pain parameters. KEYWORDS: pain, old age, substance P, questionnaires, scales, neuropathic, depression

Short-Term Outcomes of Simultaneous Inguinal Hernia Repair at Laparoscopic Appendectomy in Children: Cohort Study

Background. Nowadays, simultaneous techniques have been widely adopted in abdominal pediatric surgery as they allow to perform surgical interventions for several diseases at the same time. However, the safety of such interventions requires further studies. Objective. The aim of the study is to analyze the short-term outcomes of simultaneous hernia repair in laparoscopic appendectomy in children. Methods. The study included data from patients hospitalized with suspected acute appendicitis in 2022–2023. The study group included children operated for acute appendicitis and who had signs of patent processus vaginalis. Percutaneous internal ring suturing (PIRS) was performed in all cases. The control group (no indirect inguinal hernia was revealed) was formed by pairwise matching of patients by gender, age (± 1 year), and appendicitis type. The surgery time, the blood loss volume, the beginning of enteral feeding, and the presence of postoperative complications were analyzed. Results. The compared groups (13 individuals each) were comparable in gender (38% boys), age (median age about 10 years), and appendicitis type (catarrhal — 31%, phlegmonous — 38%, gangrenous — 31%), and white cell count at admission, presence of serous exudate and omentum changes revealed during surgery. The beginning of enteral feeding, the stool, as well as total duration of hospital stay after surgery did not differ in two groups. Moreover, both groups were comparable in terms of surgery duration, intraoperative blood loss volume, pain syndrome severity. No pyo-inflammatory complications of abdominal cavity or postoperative wounds were revealed during the hospital stay. Conclusion. Simultaneous hernia repair via PIRS method is effective and safe method of surgical management of pediatric patients with combination of acute appendicitis and inguinal hernia.

Innovative technology «Plantar Support Load Simulator (Corvit)» in medical rehabilitation of children with flat foot

For the first time, the possibility of using the innovative technology «Plantar Support Load Simulator (Corvit)» in the medical rehabilitation of children with flat feet has been scientifically substantiated. Purpose. Scientific rationale for the use of innovative technology «Plantar Support Load Simulator (Corvit)» for flat feet in children. Materials and Methods. The clinical study included 30 children with flat feet aged 7 to 17 years. The study group consisted of 15 children who were treated with the plantar support load simulator «Corvit»; the comparison group (15 children) had no exposure to the plantar support load simulator «Corvit». The children of groups 1 and 2 received a standard complex of therapeutic exercises for flat feet in children. To determine the effectiveness of using support stimulation with the plantar support load simulator «Corvit», we carried out the assessment of orthopedic status, subjective determination of the severity of pain syndrome according to the VAS, determination of the functional state of the feet in statics and dynamics (DIERS pedoscan of the DIERS formetric 4D system), and the assessment of the state of microcirculation in the foot area using laser Doppler flowmetry. Results and discussion. The conducted prospective open randomized comparative study allowed us to establish relief of pain during physical activity in the area of the legs and feet and the reduction of fatigue in most children under the influence of mechanical stimulation of support zones. According to the assessment of the orthopedic status by the DIERS pedoscan of the DIERS formetric 4D system, an improvement in the support, spring, and balancing functions of the feet was revealed, characterized by an improvement in podometry and stabilometry indicators. An improvement in the state of microcirculation has been proven according to laser Doppler flowmetry in the form of an improvement in perfusion and regulatory mechanisms of the microcirculatory bloodstream. A significantly more pronounced therapeutic effectiveness of medical rehabilitation of children using the plantar support load simulator «Corvit» for flat feet in children (86.7 %), in relation to the comparison group (53.3 %), p < 0.05, was established.

Functional status of patients after myocardial revascularization combined with chronic low back pain at the sanatorium-resort stage of medical rehabilitation

To develop an algorithm for assessing the functional status of patients after myocardial revascularization with chronic low back pain. The single-center cross-sectional cohort study (September 2021 - May 2022 yrs) included 50 patients after a myocardial revascularization with chronic low back pain (36 women, 14 men; median age 63.5 [55.5; 67.5] years), who were the study group and 10 patients with CIHD (5 women, 5 men; median age 65.0 [62.0; 68.0] years) who joined the control group. All patients underwent clinical (neurological and therapeutic examination), functional (clinical tests, echocardiography) and laboratory (general and biochemical blood analysis, blood cytokine levels) investigations, the functional class of impairment was defined. There are 4 groups with combined pain syndrome (cardiogenic and vertebrogenic) in different ratios due to different functional and laboratory status among patients after the myocardial revascularization with chronic back pain. The presence of cardiogenic pain syndrome was associated with an increase in leukocyte and peripheral blood glucose levels, interleukin-6, myocardial mass enlargement, while vertebrogenic pain syndrome correlated with personal anxiety. The evaluation of the functional status of patients according to the degree of severity of cardiogenic and vertebrogenic pain syndrome has revealed a simple method of pathogenetically based differentiation selection for individual rehabilitation program of patient development.

ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ ПРИМЕНЕНИЯ ПУЛЬСОВОЙ РАДИОЧАСТОТНОЙ АБЛАЦИИ У ПАЦИЕНТОВ С НЕВРОПАТИЕЙ ПОЛОВЫХ НЕРВОВ

The study includes medical records of patients with pudendal neuropathy (PN) who underwent the pulsed radiofrequency ablation (PRA) procedure. Clinical parameters and adverse events were studied during the entire perioperative period. The follow-up period for the respondents was at least 24 months. The study includes medical records of 25 patients (17 (68%) female respondents, 8 (32%) male respondents, the age of patients ranged from 28 to 80 years, the average age was 54.5±13.7 years) with a confirmed PN diagnosis, who underwent the PRA procedure of the pudendal nerves. Analysis of the severity of pain syndrome according to visual analogue scale (VAS) at 3, 6, 9, 12 and 24 months after the PRA procedure showed a significant decrease in this indicator (p<0.001). In the early postoperative period (the first 7 days after the operation), there was a statistically significant improvement in the level of patients’ capacity according to Oswestry Disability Index (ODI) by 10–15% in 72% (p=0.042). In the late period of the respondents’ postoperative observation, we also noted a significant improvement in the level of capacity by ODI (p<0.001). The study of the time spent in the respondents’ sitting position showed a statistically significant increase in this indicator from 29±13 minutes to 83±37 minutes 3 months after the PRA procedure of the pudendal nerves and up to 86±41 minutes after 12 months (p<0.001). There were no significant adverse clinical events in the study group of patients. PRA procedure of pudendal nerves is an effective and safe method of minimally invasive surgical treatment of patients with PN. The clinical efficacy of PRA of the pudendal nerves in the long-term period of patients’ postoperative follow-up was 92%.

Pain relief after abdominal oncologic surgery. Evaluation of the effectiveness and safety of a fixed combination of diclofenac and orphenadrine

Evaluation of the analgesic, opioid-sparing, anti-inflammatory and adverse effects of the diclofenac and orphenadrine (Neodolpasse) fixed combination for analgesia in the postoperative period of surgical cancer patients. A randomized, single-center, prospective, comparative study evaluated two analgesic regimens in 40 cancer patients undergoing various open cavity surgeries, including extensive combined interventions associated with the resection of 3 or more organs. The study was conducted following the transfer from the ICU to the surgical department during the early activation period, within the first two postoperative days. In the first group N (n=20), "Neodolpasse" (a fixed combination of 75 mg Diclofenac and 30 mg Orphenadrine) was administered as an infusion, twice daily. In the second group K (n=20) analgesia was performed with ketoprofen as an intravenous infusion at a daily dose of 200 mg. Patients in both groups received scheduled prolonged epidural analgesia with 0.2% ropivacaine, and when the severity of pain in a visual analogue scale (VAS) increased to more than 40 mm, so an additional dose of 100 mg tramadol was administered intramuscularly. Daily measurments of blood creatinine level and C-reactive protein were taken, postoperative blood loss was accounted for, as well as postoperative complications according to the Clavien-Dindo classification. The comparative analysis of the indicators of pain syndrome severity showed that the patients in group N exhibited a more pronounced analgesic effect, so on the second postoperative day 30% of patients reported moderate pain (from 50 to 60 mm on the pain scale), on the third day - 15%, and by the fourth day - all 100% of patients experienced pain of low intensity. The additional analgesia with tramadol in group N was required twice less than in the comparison group, and such adverse effects as nausea, drowsiness, and weakness were significantly more common in the ketoprofen group. In both groups, the average blood creatinine level did not exceed permissible values, and the C-reactive protein was elevated at all stages of the study but tended to decrease by the fourth day. The analysis of postoperative complications according to the Clavien-Dindo scale at the time of discharge did not reveal a direct correlation between the occurred complications and the use of NSAIDs. Adverse effects such as anastomotic failure, gastrointestinal complications, or other hemorrhagic manifestations were not recorded. The inclusion of Neodolpasse into multimodal analgesic regimens resulted in the most pronounced analgesic and opioid-sparing effects in surgical cancer patients using laparotomy access. Additionally, the application of short courses of nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with a favorable safety profile.

Bioacoustic correction in treatment of phantom pain syndrome. (Pilot study)

To assess the severity of the phantom pain syndrome in patients with consequences of combat trauma before and after comprehensive therapy using the bioacoustic correction (BAC) method. A number of male patients equal 15 aged 24-60 years with consequences of combat traumas and confirmed phantom pain syndrome were examined. Patients were given 10 BAC therapy procedures with an average duration of 20 minutes per day after a comprehensive diagnostic assessment of state. The dynamics of pain syndrome was evaluated by visual analogue scale. It has been shown that the BAC procedures contribute to a significant reduction of the phantom pain syndrome severity. The decrease of the phantom pain syndrome after the BAC procedures was maintained at least 6 months in the catamnesis. The probable mechanism of reducing the phantom pain syndrome in BAC procedures is adaptive reorganization of thalamocortical detectors of affected limbs by modulation of neuroplasticity processes. The conducted preliminary studies have shown that the BAC therapy contributes to the reduction of the phantom pain syndrome intensity.

The use of osteopathic correction in the treatment of patients with sciatic neuropathy

Introduction. In recent years, the interest of the medical community in peripheral neuropathies has significantly increased and great progress has been achieved in studying certain issues of etiopathogenesis and treatment of these conditions. The basis of therapy for piriformis syndrome (PS), as a particular form of sciatic neuropathy, is still drug therapy, but its use does not always lead to the desired results. This dictates the need to search for new, primarily non-drug, therapies as a part of the cumulative treatment of this disease. Previous work has demonstrated the possibilities of using reflexology, physiotherapy in the treatment of PS. Manual therapy has also been successfully used for a long time in the treatment of patients with this nosology, but most often only in the form of local approaches. In the available literature, there were no works evaluating the possibilities of using personalized osteopathic correction in this group of patients, as well as objectification of the complex treatment performed using ultrasound scanning. All of the above has predetermined the purpose of our research. The aim of the study was to study the results of complex therapy of patients with sciatic neuropathy (SP) with the inclusion of osteopathic correction. Materials and methods. A controlled randomized trial was conducted in the period from November 2020 to January 2022 on the basis of the profile medical clinic of LLC «Mokhov Institute of Osteopathy». We observed 22 patients aged 18 to 44 years with a diagnosis of sciatic neuropathy. Depending on the treatment used, all the observed patients were divided into the main (11 people) and control (11 people) groups using the simple randomization method. Patients of both groups received pharmacotherapy, and patients of the main group additionally underwent osteopathic correction (3 sessions with an interval of 8–10 days). All patients were assessed for osteopathic status, severity of pain syndrome and ultrasound diagnostics with assessment of the condition of the involved sciatic nerve. Evaluation and measurements were carried out before the start of treatment and 30 days after its start. Results. In patients with sciatic neuropathy, regional biomechanical disorders of the regions were most often detected: pelvis, structural and visceral components (45,5 % and 68,2 % respectively), dura mater (59,1 %), lumbar, visceral component (45,5 %). Among the local somatic dysfunctions (DM), the dysfunction of individual vertebral-motor segments was most often determined at the level of the cervical (18,2 %), thoracic (18,2 %) and lumbar (22,7 %) spine, individual joints of the lower extremities (22,7 %), individual skull sutures (27,3 %). After treatment, only in patients of the main group, a statistically significant (p<0,05) decrease in the frequency of detection of regional biomechanical disorders of the pelvic region (structural and visceral component), TMO was obtained. For the rest of the SD, the differences were not significant. The examined patients were characterized by moderate pain syndrome. The therapy, both with and without osteopathic correction, has shown good results. In patients of both groups, there was a significant (p < 0,05) decrease in the intensity of pain syndrome, but in the main group these changes were significantly more pronounced. Patients with sciatic neuropathy were characterized by an increased thickness of the nerve and a decrease in its echogenicity according to the results of ultrasound diagnostics. Against the background of therapy, patients of both groups have a decrease in nerve thickness, but in the main group these changes were statistically significant (p < 0,05) more pronounced. But normalization of nerve echogenicity was observed only in patients of the main group who received osteopathic correction (significant changes, p < 0,05). Conclusion. The use of osteopathic correction in the framework of complex therapy of patients with sciatic neuropathy allows to achieve a statistically more significant reduction in the intensity of pain syndrome and normalization of nerve structure (according to ultrasound data) compared with the isolated use of drug therapy. It is advisable to continue the study on a larger sample of patients.