Severity Of Pain Syndrome Research Articles

Практичні аспекти застосування парентеральної озонотерапії у лікуванні різних контингентів хворих

In Ukraine, parenteral ozone therapy has been successfully used for many years in the treatment of injuries, poisonings, infectious and non-infectious diseases. Clinical evaluation of the effectiveness of ozone therapy is carried out by doctors based on various approaches and using a wide range of biomarkers. Aim. Analysis of the results of the practical use of parenteral ozone therapy and determination of parameters of its clinical effectiveness in the treatment of patients in the intensive care unit. Materials and Methods. Summarized results of treatment of 144 patients with poisoning, injuries, infectious and somatic diseases, aged 18–72 years, women ‒ 84 (58.3%), men ‒ 60 (41.7%), who underwent a course of parenteral ozone therapy in 2017-2021 in the CNE Kyiv City Clinical Hospital of Emergency Medical Care and ozone therapy rooms of private clinics. Parenteral ozonation of blood was carried out with the help of devices of the "Bozon-N-plus" series following the methodology approved by the Ministry of Health of Ukraine ("Methods of ozone therapy", 2001). The methods of systematic, comparative and statistical analysis were used. Results. All patients were divided into 5 clinical groups based on the nature of their disease: the first group ‒ patients with acute poisoning by substances of suffocating hemotoxic effect; the second group ‒ patients with acute infectious diseases; the third group ‒ patients with chronic non-infectious diseases; the fourth group ‒ patients with purulent wounds; the fifth group ‒ patients with drug addiction. Criteria for evaluating the effectiveness of ozone therapy were used for each clinical group. A total of 1423 medical procedures using ozone were performed. The average course of treatment consisted of 3 to 10 procedures. Among them, 313 procedures of intravenous infusion of ozonated physiological solution (200 ml, ozone dose ‒ 0.48 mg, procedures were performed daily or every other day) were performed. 1110 procedures of intravenous infusion of ozonated autologous blood (200 or ‒ 400 ml of autologous blood, ozone dose ‒ 1.8 or 3.6 mg) were performed. The beginning of the course of autohemotherapy was preceded by a session of intravenous administration of ozonated physiological solution (the first procedure), after which the course of autohemotherapy began, with a frequency of 2-3 times a week. Conclusions. The clinical effectiveness of ozone therapy has been confirmed through a complex dynamic assessment of the patient's condition, which involves the use of subjective assessments (well-being, mood, duration of sleep, severity of pain syndrome, etc.) and objective parameters of the patient (clinical, functional, laboratory indicators, specific biomarkers). Keywords: chemical poisoning, ozone therapy, blood ozonation.

The effectiveness of the use of synbiotics in the complex therapy of acute intestinal infections in children

Relevance. Acute intestinal infections in children retain a high value in the structure of child morbidity and mortality, which necessitates the search for means and methods for their active treatment and improvement of prognosis.
 Aim: to determine the effectiveness of the use of synbiotics in the complex therapy of acute intestinal infections in children at the outpatient stage.
 Materials and methods. Fifty 6–17 years children with mild or moderate acute intestinal infections were examined. The patients were divided into the main group (30 children) and the control group (20 children), the groups were comparable. Patients from the main group, along with pathogenetic therapy, received a combination of Lacticaseibacillus paracasei DG I-1572 DSM 34154 
 (L. casei DG) and fructooligosaccharides (FOS), and children from the control group received only pathogenetic and symptomatic treatment. Clinical symptoms were evaluated over following up included temperature, frequency and, nature of stool, presence and severity of dyspeptic manifestations, nausea, frequency of vomiting, presence and severity of abdominal pain syndrome. Statistical data processing was carried out using statistical analysis Statistica v. 13.0 (StatSoft Inc., USA).
 Results. The combined use of L. casei DG and FOS in the pathogenetic therapy of acute intestinal infections reduces the time of relief of clinical manifestations. The severity of abdominal pain syndrome regresses significantly faster when using this synbiotic. Norma­lization of the frequency and nature of stool occurs significantly faster with the simultaneous appointment of pathogenetic therapy and the synbiotic. The combination of L. casei DG and FOS has demonstrated a high safety profile, side effects have not been reported.
 Conclusion. It is advisable to prescribe the combination of L. casei DG and FOS from the first day of acute intestinal infections alongside with pathogenetic and symptomatic therapy to achieve a clinical effect more quickly.

Assessment of the quality of life in complex medical rehabilitation of patients at the stage of chemoradiotherapy for head and neck cancer

BACKGROUND: At the stage of chemoradiotherapy of malignant neoplasms of the head and neck, in 90% of cases, the development of radiation dermatitis and mucositis is observed. The resulting acute radiation reactions negatively affect not only the quality of life of the patient, but also the planned treatment. A multidisciplinary approach with the inclusion of basic treatment, physical therapy, physical factors, psychological correction, and nutritional support is an effective strategy for improving the patient's quality of life at this stage of treatment. AIM: To assess the quality of life of patients in complex medical rehabilitation who underwent chemoradiotherapy for malignant neoplasms of the head and neck. MATERIALS AND METHODS: An interventional prospective randomized study was conducted with the participation of 60 patients with malignant neoplasms of the oral cavity, larynx, oropharynx, larynx undergoing chemoradiotherapy. The main group (n=30) received a course of medical rehabilitation: exposure to low-temperature argon plasma, general magnetic therapy, physical therapy, training on the support reaction on a barefoot platform, nutritional support and classes with a medical psychologist. In patients of the comparison group (n=30), plasma exposure was not included in the rehabilitation course. The effect of chemoradiotherapy for head and neck cancer on the patient's quality of life was assessed by the severity of pain syndrome, physical functioning, and limitations of daily activities using Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale (HADS) techniques, a questionnaire developed by C.D. Spielberger and adapted by Y.L. Khanin, the SF-36 questionnaire. RESULTS: After a course of chemoradiotherapy, patients began to complain of pain, burning in the mouth, complaints of dry mouth, pain when swallowing, eating, limited mouth opening, redness and peeling of the skin, voice changes, difficulty falling asleep, frequent awakenings at night, embarrassment of one’s appearance. In patients of both groups, there was a decrease in the level of reactive and personal anxiety, the increased level of anxiety and depression decreased by the end of the course of chemoradiotherapy with a decrease in indicators after 6 months. Despite the increase in pain intensity during chemoradiation treatment, an increase in vital activity indicator was recorded, as well as an indicator of self-assessment of one’s health by the end of the course of chemoradiation treatment. CONCLUSION: The resulting radiation mucositis and epidermitis at the stage of chemoradiotherapy for head and neck cancer lead to physical and psychological limitations, worsening the patient's quality of life, which determines the need to accompany this stage of treatment with comprehensive medical rehabilitation. The study of the dynamics of the parameters of the quality of life of patients is the basis for the selection of individual rehabilitation treatment programs.

The Impact of Vaccination Status on the Severity of Pain Syndrome in COVID-19 Patients

COVID-19 has a lot of different symptoms, and pain syndrome is one of them. Getting a COVID-19 vaccine cut down on illnesses with symptoms and/or high viral loads. The study's goal is to find out how bad the pain syndrome is in people who have been vaccinated against COVID-19 and people who have not been immunized. A cross-sectional observational study was done on 304 COVID-19 patients from September 2021 to April 2023. The patients' ages ranged from 18 to 65. After they gave written permission, the people who took part in the study were given an electronic form with 20 questions. The study subjects were split into 5 groups based on their vaccine status: those who had not been vaccinated, those who had been partially vaccinated (≥ 14 days after dose 1 or < 14 days after dose 2), those who had been fully vaccinated (≥ 14 days after dose 2), those who had been vaccinated after the third dose, and those who had been vaccinated after the fourth dose. All subjects, vaccinated and not vaccinated, had pain syndrome symptoms, and there were no significant differences (P>0.05). A lot of people who weren't protected (40.2% of them) reported severe pain. In the group that got the fourth dose, however, it was not found at all (0%). It was (29.7%), (38.7%), and (39.1%) in the groups that had been partly vaccinated, fully vaccinated, and given the third dose of the vaccine, in that order. In conclusion, pain syndrome was found in all COVID-19 patients. The pain was much worse in patients who had not been vaccinated, but not in those who had gotten the fourth dose of the vaccine.

Assessment of pain intensity and methods of its relief in patients with irritable bowel syndrome

Objective — to develop a questionnaire for assessing the condition of patients with irritable bowel syndrome (IBS); to evaluate clinical effectiveness of personalized diet, synthetic agonist of peripheral opioid receptors m‑, k‑, and d‑ trimebutine maleate, and complex pro‑prebiotic drug (Lactobacillus acidophilus 500 million, Lactobacillus rhamnosus 1 billion, Sacchromyces boulardii 30 million, Bifidobacterium lactis 275 million, Bifidobacterium longum 1 billion, Clostridium butyricum 2 million, Bacillus clausii spores 2 billion, Fructo oligosaccharides 100 mg) in patients with IBS.
 Materials and methods. To evaluate the clinical effectiveness of the treatment, 28 patients with IBS have been examined. The investigated group included 15 (53.6%) patients with IBS and diarrhea, 11 (39.3%) subjects with mixed IBS, and two (7.1%) patients with IBS and constipation. The age of the patients was 32.5±3.1 years; from them 17 (51.7%) were women and 11 (39.3%) men. Nine women (52.9%) and five (45.5%) men were married, and 11 (64.7%) women and 7 (63.3%) men had higher education. The average duration of the disease in women was 3.4±1.8 years, and 3.1±1.5 years in men. The diagnosis of IBS was established according to the Rome criteria IV revision. Defecation was evaluated according to the Bristol stool scale. All patients filled out the «Questionnaire for a patient with irritable bowel syndrome» before the treatment start and during the treatment. The examined patients were prescribed a personalized diet with account their nutritional status, and drug therapy that included trimebutine maleate (film‑coated tablets) in a dose of 200 to 600 mg depending on pain intensity, and synbiotic (Lactobacillus acidophilus, Lactobacillus rhamnosus, Sacchromyces boulardii, Bifidobacterium lactis, Bifidobacterium longum, Clostridium butyricum, Bacillus clausii spores, Fructo oligosaccharides) in a dose of one capsule twice a day, regardless of the severity of the pain syndrome.
 Results. Complex treatment with the use of personalized dietary recommendations, synthetic agonist of peripheral opioid receptors trimebutine maleate and synbiotic that included Lactobacillus acidophilus, Lactobacillus rhamnosus, Sacchromyces boulardii, Bifidobacterium lactis, Bifidobacterium longum, Clostridium butyricum, Bacillus clausii spores, Fructo oligosaccharides, promoted to the decrease of pain syndrome severity, improvement of the psychoemotional state and quality of life of patients.
 Conclusions. The developed questionnaire for a patient with IBS was comprehensible and easy to fill out by patients; it allowed a practitioner to quickly analyze the dynamics of the pain syndrome. Personalized dietary treatment, a differentiated approach in administration of the peripheral opioid receptor agonist trimebutine maleate and synbiotics (Lactobacillus acidophilus, Lactobacillus rhamnosus, Sacchromyces boulardii, Bifidobacterium lactis, Bifidobacterium longum, Clostridium butyricum, Bacillus clausii spores, IBS oligosaccharides) was clinically effective for patients with IBS, it promoted the significant pain relief and improvement of the quality of life of patients.

Efficacy of comprehensive dental treatment for lichenoid reactions of the mucoparodontal complex: A single-center pilot cohort study

Background. Lichenoid reactions of the oral mucosa are currently recognized as a serious issue for dentists of various specialties, since their knowledge and competence in the diagnosis and pathogenetic treatment of lichenoid lesions of the oral cavity are yet to be improved. Following the data on high oncogenic potential in some forms of lichenoid reactions of oral cavity mucous membranes, the issue should be given serious considerations, and dentists should keep oncology-related suspicion when receiving these patients.Objective. To evaluate the efficacy of comprehensive dental treatment for lichenoid reactions of the mucoparodontal complex.Methods. A single-center pilot cohort study was conducted to evaluate the efficacy of the comprehensive treatment (combination of pharmacotherapy and physiotherapy) of patients with lichenoid reactions of the oral mucosa. The observation group consisted of 49 patients (15 males, 34 females) aged 58.92 ± 0.82 years with verified diagnoses of oral mucosa lichenoid reactions. The suggested treatment included pharmacotherapy (highly-potent topical steroids, calcineurin inhibitors) and physiotherapy in the form of low level laser therapy (635 nm, 10 W) provided via Matrix laser (Matrix, Russia). Treatment efficacy was assessed by the total scale of treatment efficacy, registering indicators of the area of focal lesions and the severity of pain syndrome, as well as by changes in dental quality of life indicators according to OHIP-49-RU (Oral Health Impact Profile) in the Russian version. Statistical processing of the data involved Student’s t-test and Wilcoxon t-test. Differences were considered significant at p ≤ 0.05. Data statistical analysis was performed using SPSS 13.0 (SPSS Inc., USA).Results. During the follow-up period, the indicators of the total scale of treatment efficacy decreased significantly (p < 0.001) in 100% of patients and amounted (as medians and quartiles): 6.0 (4.0–7.0) points before treatment and 1.0 (1.0–2.0) points after treatment to be objectified by a significant reduction in the area of focal lesions (by 63.2%, p < 0.001) and in pain syndrome (spontaneous pain from 2.0 (1.5–3.0) points before treatment to 0.0 (0.0–1.0) points after treatment; induced pain from 3.0 (2.0–3.0) points to 1.0 (0.0–1.0) points). Along with the clinical improvement, the scores in dental quality of life improved from 83.11 ± 2.58 to 39.94 ± 0.86 points, according to OHIP-49 RU (Oral Health Impact Profile).Conclusion. Early detection and differentiation of lichenoid reactions in oral mucous membranes ensure timely treatment using the developed protocol of comprehensive treatment (combination of pharmacotherapy and physiotherapy). The efficacy of the protocol was confirmed clinically and justified in relation to quality of life.

Comparative evaluation of the perioperative anesthesia methods for cancer patients undergoing pancreaticoduodenectomy

BACKGROUND: Pancreatoduodenal resections are one of the most traumatic and technically complex interventions in abdominal surgery. The correct anesthetic management and pain relief allow to substantially reduce the risk of perioperative complications, which remains high even in high-volume oncology centers with extensive experience. Finding new components and methods of anesthesia combined with evaluation of their effectiveness and safety remains a pressing issue.
 AIM: To evaluate the efficacy and safety of using intravenous lidocaine infusion as a component of anesthesia and postoperative analgesia in cancer patients during pancreatoduodenal resection.
 MATERIALS AND METHODS: We analyzed the course of anesthesia, operation and postoperative period of 43 patients (mean age 63.2±7.1 years) undergoing pancreaticoduodenectomy. For the purposes of the study, patients were randomly divided into 2 groups, based on anesthesia method: for the first group (n=19) we used epidural analgesia as a component of perioperative anesthesia, for the second group (n=24) we used prolonged intravenous infusion of lidocaine at an average dose of 1 mg/(kg×h). We analyzed the severity of pain syndrome according to Numeric rating scale for pain in postoperative period, as well as opioid requirement, the time of gastrointestinal function recovery, and post-operative complications frequency. In order to prevent systemic toxicity, drug monitoring was carried out — the determination of the plasma concentration of lidocaine.
 RESULTS: Perioperative opioid requirement was comparable between groups, with no statistically significant differences observed. The degree of pain syndrome according to the Numeric rating scale for pain did not differ statistically, except for the number of points during activation on day 3: 4.00 (95% confidence interval 3.49–4.51) for epidural analgesia group, compared to 3.12 (95% confidence interval 2.64–3.61) for lidocaine infusion group, p=0.014. There was also a statistically significant increase in infusion volume for epidural analgesia group compared to lidocaine infusion group [8.83 ml/(kg×h) (Q1=7.90; Q3=10.06) and 7.33 ml/(kg×h) (Q1=6.28–Q3=8.49) respectively, p=0.034], as well as a greater need for intraoperative vasopressor support among the patients [15 (78.9%) and 10 (43.5%) respectively, p=0.029]. In the lidocaine group, the time to onset of peristalsis was significantly shorter than in the epidural analgesia group [median 48.0 h (Q1=48.00; Q3=72.00) compared to median 60.0 h (Q1=36.00; Q3=64.50) respectively, p=0.042]. The frequency of postoperative complications did not differ between the groups.
 CONCLUSION: Based on a comparative analysis of the study results, it can be concluded that prolonged intravenous infusion of lidocaine, as a component of perioperative anesthetic protection during pancreatoduodenal resections, is safe and comparable in terms of analgesic efficacy to epidural blockade.

Effectiveness of Physiotherapy Methods in Medical Rehabilitation of Patients with Shoulder and Scapular Pain Syndrome in a Sanatorium: a Randomized Clinical Study

INTRODUCTION. The high prevalence of shoulder pain syndrome (SPS) determines the relevance of the development of new comprehensive methods of rehabilitation of this category of patients.
 AIM. To evaluate the clinical effectiveness of shockwave therapy (SWT) and pulsed low-frequency electrostatic field (PLEF) in patients with SPS undergoing medical rehabilitation in a sanatorium-resort organization in comparison with traditional health resort treatment.
 MATERIALS AND METHODS. The comparative analysis of medical rehabilitation efficiency was carried out in 90 patients with SPS aged 31–68 years undergoing medical rehabilitation in the health resort complex “Vulan” — a clinical branch of National Medical Research Center for Rehabilitation and Balneology. All patients were divided into 3 groups of 30 persons each by the method of simple randomization. Group 1 patients (control) received traditional health resort treatment, including ozokeritotherapy, physical exercise therapy, electrotherapy with sinusoidal modulated currents and manual massage. Patients of the second group (comparison) received against the background of the above complex 3 SWT procedures on the shoulder joint once a week. Group 3 patients (main group) received, in addition to traditional treatments, 3 SWT and 8 field PLEF treatments administered every other day. The effectiveness of rehabilitation was evaluated according to the severity of pain syndrome (VAS scale), Swanson’s scale for the shoulder. Movement volume before and after rehabilitation was measured with an orthopedic angle gauge. Microcirculation state was assessed by laser Doppler flowmetry (LDF). Leukert scale was used to assess the state of well-being. The results of the study were assessed 18 days after the beginning of rehabil itation measures.
 RESULTS AND DISCUSSION. Patients who additionally received SWT and PLEF against the background of traditional health resort treatment noted a significant reduction in the severity of pain syndrome, while in the main group pain regression was noted earlier (on day 4–5), whereas in the comparison group the same results were obtained by the day 14th . In the control group, patients noted significant changes on the VAS scale only by the end of the rehabilitation course. On the Swanson scale, the most significant positive results were also obtained by the patients in the main group: the pain decreased on average 2.6-fold, the volume of active movements in the shoulder joint increased 2.7-fold, and activity in everyday life 1.9-fold. Statistical differences in the Swanson Scale scores with the comparison group were obtained with regard to pain syndrome and volume of active movements. When comparing with the control group, reliable differences were revealed in all Swanson’s scale indicators in both the main group and the comparison group. When studying the dynamics of microcirculation according to LDF data, it was noted that reliable changes in the main indices of the LDF-gram were revealed only in the groups that received innovative physical therapy interventions.
 CONCLUSION. Thus, the inclusion of modern physiotherapeutic techniques of SWT and PLEF into the program of health resort treatment of patients with SPS allows to increase significantly the efficiency of medical rehabilitation carried out in the sanatorium organization.

The effect of polyneuropathy severity on nerve conduction and pain syndrome in patients with type 2 diabetes

Background. The article examines the relationship between nerve conduction indicators and polyneuropathy severity in patients with type 2 diabetes. The influence of polyneuropathy severity on nerve conduction was studied, as well as the effect of insulin therapy on these indicators. Objective: to determine the influence of polyneuropathy severity and the need for additional insulin administration in patients with type 2 diabetes on nerve conduction indicators and the development of pain syndrome. Materials and methods. Eighty patients with type 2 diabetes were examined, 49 men and 31 women. All of them underwent general clinical and biochemical laboratory tests to evaluate the hematopoietic system, li-ver, kidneys, fat and carbohydrate metabolism. The need for insulin therapy was assessed by the C-peptide level. To verify the diagnosis of diabetic polyneuropathy, complaints, clinical and instrumental examination data were evaluated. The main indicators of nerve conduction were taken into account when determining polyneuritis disorders, namely: рeroneal motor nerve conduction velocity, sensory nerve action potential of the sural nerve, sensory nerve conduction velocity of the sural nerve. Results. A dependence of nerve conduction on polyneuropathy severity was revealed, рeroneal motor nerve conduction velocity was the lowest in the group with severe polyneuropathy. A correlation was also found between the levels of sensory indicators (sensory nerve action potential and sensory nerve conduction velocity) and polyneuropathy severity, nerve conduction velocity decreases with an increase in the latter. The influence of polyneuropathy severity on the painful or painless form has been found. Among patients with severe polyneuropathy, the painful form was observed more often. No relationship was found between the need for insulin therapy and the painful or painless form of polyneuropathy. Conclusions. Indicators of nerve conduction depend on polyneuropathy severity. The presence and severity of pain syndrome directly depends on polyneuropathy severity. The need for additional insulin administration affects sensory indicators but has no effect on the development of the painful form of polyneuropathy.

Possibilities of modern pharmacotherapy in patients with dysfunction of the sphincter of Oddi

Pain in the right hypochondrium is one of the most frequent complaints in patients with diseases of the biliary system. According to statistics, every tenth person experiences unpleasant sensations in the upper right abdomen after drinking alcohol, fatty, fried or salty food, as well as after psychoemotional and physical exertion. The most common of the pathologies of the biliary system is the sphincter of Oddi dysfunction (SOD). SOD is a clinical syndrome caused by a functional disorder of sphincter of Oddi (SO), which leads to the development of abdominal pain syndrome, increased activity of liver and / or pancreatic enzymes, dilatation of the common bile duct and the main pancreatic duct. One of the methods of treatment of SOD is drug therapy, accompanied by the following groups of drugs: antispasmodics, nitrates, choleretics, antidepressants, etc. At the same time, many medications show low efficacy against SOD, or cause pronounced side effects. At present, for the treatment of sphincter of Oddi dysfunction, the domestic drug from the group of myotropic antispasmodics, hymecromon, Holicron, has the optimal characteristics in terms of price-quality ratio in the Russian pharmacological market. The drug has a selective antispasmodic effect on SO, and also has a choleretic effect. Mechanism of antispasmodic action is an increase in the concentration of nitric oxide (II) and cyclic mononucleotides, which through a cascade of biochemical reactions leads to a decrease in the number of calcium ions in the cell and a decrease in the tone of smooth myocytes of SO and gallbladder. The drug is absorbed into the blood in a small amount, which excludes its systemic effect and determines the selectivity of the effect on the biliary system. According to the results of clinical testing and consideration of a specific clinical case, it can be concluded that the use of hymecromone (Holicron) reduces the severity of pain syndrome and reduces dyspepsia syndrome, good tolerability and absence of side effects that would require withdrawal of the drug are also recorded.

Relationship between the pain severity, use of non-steroidal anti-inflammatory drugs and blood pressure in elective large joint arthroplasty of the lower extremities

To evaluate the changes in blood pressure (BP), the severity of pain syndrome and non-steroidal anti-inflammatory drugs (NSAIDs) use patterns in patients hospitalized for elective arthroplasty of large joints of the lower extremities during the postoperative period. This study included 374 patients. In all patients, medical history, antihypertensive therapy and history of NSAIDs usage were collected, BP was measured, and the severity of pain was assessed via a 10-point scale before surgery, as well as 1 and 3 months after arthroplasty. The study included 132 (35.3%) males and 242 (64.7%) females. Among these, 289 (77.3%) patients had hypertension [grade 1 - 35 patients, grade 2 - 136 patients, grade 3 - 118 (25.0%) patients]; 280 (74.9%) patients were taking NSAIDs (121 - daily, 135 - 2-3 times per week). The median pain severity before surgery was 8 points [7; 9], 1 month after surgery - 2 points [1; 4], 3 months after surgery - 1 point [0; 3]. At 1 month after arthroplasty, 23 (7.9%) patients reported a decrease in BP. In 17 (5.9%) patients, correction of previously prescribed antihypertensive therapy with a decrease in drug doses was required. At 1 month after arthroplasty, 256 patients discontinued NSAIDs. The analysis of the relationship between the severity of pain, NSAIDs use and the level of BP revealed a significant effect of pain syndrome (p<0.0001) and the use of NSAIDs (p=0.014). In the population of patients with elective arthroplasty of large joints of the lower extremities, a significant incidence of hypertension and a high prevalence of NSAIDs use are noted. During the postoperative period, a significant trend towards a decrease in the severity of pain was found, as well as the relationship of pain and NSAIDs with a decrease in BP.

The use of a combination of Diclofenac and Orphenadrine for analgesia in knee replacement

The objective was to assess the effectiveness and safety of the use of a fixed combination of Diclofenac and Orphenadrine (Neodolpasse) for analgesia in patients who underwent knee replacement.Materials and methods. 40 patients who underwent knee replacement in conditions of combined spinal-conduction analgesia (femoral nerve block) were included into the study. In the main group(n = 20), Neodolpasse (a combination of Diclofenac 75mg and of Orphenadrine 30 mg in 250 ml of solution) was administered intravenously 30 minutes before surgery, and then in the postoperative period 2 times a day for 2 days. In the comparison group (n = 20), Ketoprofen (intravenously,100 mg) was used instead of Neodolpasse 30 minutes before surgery, in the postoperative period, it was continued 2 times a day for 2 days (intravenously, 100 mg). The severity of the pain was assessed with a visual analog scale (VAS) 6, 12, 24 and 48 hours after surgery. The assessment of the restoration of the supporting function of the operated leg and the ability of the patient to perform active movements in the knee joint was carried out after 24 and 48 hours. The possible side effects was assessed throughout the entire period.Results. The median value of VAS after 24 hours in the main group was 2.5 (2;3) points, which was significantly lower in compassion to VAS of the control group 4(3;5) p = 0.006. A more pronounced analgesic effect while using Diclofenac and Orphenadrine persisted for 48 hours, the median value of VAS in the main group after surgery was 2 (2;3), in the control group – 3 (2.8;4) p = 0.021. There were no significant differences in the recovery time of restoration of the supporting ability of the operated leg and knee joint function, in the frequency of Tramadol use in the compared groups. Side effects and complications were not identified. Conclusion. The use of the fixed dose of Neodolpasse as part of multimodal perioperative analgesia in patients, who underwent knee replacement, contributed to a decrease in the severity of pain syndrome in the postoperative period.

The rationale for the choice of preventive intraoperative anesthesia for uterine curettage in patients with individual intolerance to amide anesthetics

Background. Uterine curettage (UC) is widely used in global clinical practice owing to its great diagnostic and therapeutic value. At the same time, UC leads to a damage to the integrity of soft tissues, causing development of postoperative pain syndrome. Some patients have an individual intolerance to amide anesthetics, which limits their use in this cohort. Purpose: to improve the quality of providing anesthetic care in the early postoperative period after UC to women who have a history of individual intolerance to amide anesthetics through selection of a comprehensive method of preventive intraoperative anesthesia for this category of patients. Materials and methods. Ninety females took part in the study. Clinical, laboratory, and mathematical and statistical research methods were used to study the preventive analgesic effectiveness of the compared methods of anesthesia. Five samples of biological material, called the control points, were taken: before surgery, immediately after it, then 1, 3 and 6 hours after intervention. In this way, an idea was got about the initial level of the studied indicators and their changes during the postoperative stay in the hospital. Properties of various combinations of propofol, ketamine, fentanyl, and dexketoprofen were studied. Results. It was revealed that a combination of propofol (2 mg/kg), fentanyl (0.1 µg/kg), ketamine (0.1 mg/kg), as well as additional intravenous administration of dexketoprofen (50 mg) at the stage of premedication has the advantages in terms of preventive intraoperative analgesia. Effectiveness of the proposed method of anesthesia was proved by significantly better indicators of vital functions (heart rate, mean arterial pressure) and serum levels of some laboratory markers of stress (glucose, cortisol, insulin, cortisol-insulin index). Differences in the studied parameters were recorded both when comparing them between the groups at the same control time points and conside-ring the development and regression of the postoperative pain syndrome severity within the groups. Conclusions. The proposed method of anesthesia has a reliable advantage in terms of preventive reduction of the postoperative pain syndrome of UC in patients who cannot have application anesthesia due to individual intolerance to amide drugs. The specified method has a positive effect on vital functions and serum levels of some laboratory markers of stress, and the fastest recovery of patients is caused by a lower suppressive action of the anesthetic drugs used.

«Locomotive syndrome» in patients in the geriatric hospital

The study aim was to analyze the prevalence and course of locomotive syndrome in patients in the geriatric hospital.Materials and methods. This work was a cross-sectional study performed on the basis of the Moscow War Veterans Hospital N3. The study enrolled 58 patients – 43 women (74.1%) and 15 men (25.9%) hospitalized in the geriatric department of the hospital. The mean age of study patients was 82.7+5.9 years, varying from 75 to 96 years. A comprehensive geriatric assessment was performed, including the Age Is Not a Barrier Questionnaire, the Basic Daily Activity Scale (Bartel Index), the Instrumental Activities of Daily Living (IADL) Scale, and the Morse Falls Scale. Questionnaires were filled out to assess the locomotive syndrome – GLFS‑5 and GLFS‑25. A 2 step test was carried out.Results. In 48 out of 58 patients (82.8%), locomotive syndrome was found: in 88.4% of women and in 66.7% of men (p=0.05). Locomotive syndrome was diagnosed in all centenarians, in 82.7% of patients aged 80 to 89 years and in 75% of patients aged 75–79 years. The main cause of the locomotive syndrome was degenerative-dystrophic changes in the spine and joints observed in all patients. Only 1 patient had stage I locomotive syndrome, all the rest had stage II. Patients with locomotive syndrome had lower levels of activity in everyday life – 84.3±11.2 and 93.0±6.3 points according to the Barthel index, respectively (p=0.01), greater severity of pain syndrome according to VAS – 4.2±1.8 and 1.7±1.6 points, respectively (p=0.003) and a shorter distance of 2 steps (123.3±30.9 and 148.1±20.7 cm, respectively (p=0.003). Direct correlations were established between the values of the GLFS‑5 locomotive function scale and the age of patients (r=0.33; p=0.01), as well as the severity of chronic pain syndrome according to VAS (r=0.55; p=0.00007). Inverse relationships were registered between the indicators of the GLFS‑5 scale and the Barthel index (r= –0.44; p=0.0005), the IADL scale (r= –0.41; p=0.001) and the distance traveled in the «2 steps» test (r= –0.52; p=0.0007). Inverse correlations were observed between the values of the GLFS‑25 scale and the Barthel index (r= –0.41; p=0.008), the IADL scale (r= –0.59; p=0.00008), the Mini-COG test (r= –0.37; p=0.02), as well as indicators of bone mineral density in the proximal femur (r= –0.39; p=0.04 – r= –0.54; p=0.002). Conclusions. The study results indicate that patients in the geriatric hospital very often have locomotive syndrome associated with the pathology of the musculoskeletal system. The severity of the locomotive syndrome correlates with the indicators of the functional activity of patients, the intensity of the pain syndrome and the bone mineral density.

Psychological aspect of pain syndrome in endometriosis

Relevance. Endometriosis is a multifactorial gynecological disease characterized by a benign proliferation of endometrial cells outside the uterine cavity. At the present stage of the study of endometriosis, the etiology and pathogenesis of its development have not been studied enough. More and more attention is paid to the emotional and personal characteristics of patients, and the disease itself is gradually moving into the category of psychosomatic disorders.The objective was to identify the features of the perception of pain syndrome, as well as emotional, personal characteristics and the level of adaptation of women with endometriosis.Methods and materials. The study involved 76 respondents: 46 women with endometriosis and 30 women without gynecological pathology (conditionally). We used psychodiagnostic questionnaire methods aimed at studying the perception of pain syndrome, emotional sphere, level of adaptation, personal characteristics and gender identity.Results. The personal profile of women with endometriosis is dominated by such traits as: anxiety, depression, difficulties in controlling life events, a decrease in the level of socio-psychological adaptation and satisfaction with the quality of life, a tendency to escape from reality in comparison with the personal profile of conditionally healthy women. It has been established that a higher assessment of the severity of pain syndrome in endometriosis is interconnected with such types of interpersonal interaction as «dependent-obedient» and «cooperating-conventional».Conclusions. The treatment and rehabilitation of patients with endometriosis requires taking into account their psychological characteristics, as well as a multidisciplinary approach involving specialists of various profiles, including psychologists/ psychotherapists.

Evaluation of Patient Expectations for Surgical Treatment of Degenerative Disease of the Lumbosacral Spine

Objective. To determine the main demographic factors that influence preoperative expectations of patients with degenerative diseases of the lumbosacral spine.Material and Methods. A cross-sectional study was performed for 103 patients with degenerative diseases of the lumbosacral spine who were scheduled for surgery in the period from 2019 to 2021. General demographic data, level of patient’s education and the presence of previous surgeries were taken into account. Expectations for surgical treatment outcome were assessed using a translated and adapted Russian version of the Hospital for Special Surgery – Lumbar Spine Surgery Expectations Survey (HSS-LSSES) questionnaire. The quality of life of patients was assessed using the general questionnaires: European Quality of Life-5 Dimensions (EQ-5D-5L) and the 36-item Short-Form Health Survey (SF-36), as well as the disease-specific Oswestry Disability Index (ODI).Results. It was found that, according to HSS-LSSES, patients’ expectations for the upcoming surgical intervention are the higher, the older the patient’s age, the higher the general and emotional state of health, vitality, ODI scores, as well as the severity of pain syndrome, and the lower the mental health score. Patients with a high level of education and prior spinal surgery have lower expectations for subsequent surgery.Conclusion. The expectations of patients for the surgical treatment for degenerative disease of the lumbosacral spine depend on the patient’s age, level of education, anamnesis and severity of decline in the quality of life.

The impact of vaccination status on the severity of pain syndrome in COVID-19 patients of Al-Rayan Colleges, Al Madinah

The impact of vaccination status on the severity of pain syndrome in COVID-19 patients of Al-Rayan Colleges, Al Madinah

Сравнительная оценка эффективности использования препаратов с экстрактом предстательной железы в комплексной терапии пациентов с хроническим простатитом.

Introduction. Chronic prostatitis (СР) is an inflammation of the prostate tissue, including non-infectious genesis. This is the most common urological disease in men under 50 years of age and the third most common in people over 50 years of age. A promising and actively studied direction of conservative therapy of the inflammatory process in the prostate gland is the use of drugs of animal origin based on prostate extract. The purpose.This work is devoted to the comparative characteristics of drugs with prostate extract effectiveness in the complex therapy of patients with chronic prostatitis. Materials and methods. Retrospective analysis of medical records of 125 patients with a previously established diagnosis of СР of the II and IIIA, and IIIB categories aged from 22 to 55 years was performed. Depending on the preparation used with prostate extract in the complex therapy of CP, patients were divided into 5 groups. Preparations with prostate extract were used for 20 days. The effectiveness analysis included an assessment of the dynamics of the clinical picture, the results of laboratory and instrumental research methods, as well as questionnaire data on valid questionnaires I-PSS (International System for the Summary Assessment of Prostate Diseases, Lower Urinary Tract Symptoms (LUTS)), IIEF-15 (International Index of Erectile Function), NIH Chronic Prostatitis symptom Scale- CPSI. Results. The analysis of the results showed that the use of Vitaprost® in the complex therapy of СР is accompanied by a decrease in the number of leukocytes in the analysis of prostate secretion, positive dynamics in relation to the total score of the severity of pain syndrome and the patient's assessment of his condition on the NIH-CPSI scale of symptoms of chronic prostatitis, which may indicate a decrease in the inflammatory process in the prostate in general. The effectiveness of therapy in relation to erectile function on the IIEF-15 scale, reduction in the severity of symptoms on the IPSS scale and positive dynamics in relation to urination parameters was also noted. Conclusion. According to the results of the work carried out, it was the use of Vitaprost® that was accompanied by a significant decrease in the symptoms of CP and an improvement in the quality of life of patients, as well as erectile function of patients, an increase in the flow rate of urine, a decrease in the volume of residual urine and intensiveness of inflammation.

Experience of Endoscopic Transcapsular Axillary Nerve Decompression

INTRODUCTION Posttraumatic axillary nerve neuropathy is a widely spread pathology, more often seen after shoulder joint trauma. It can also occur as a complication after orthopaedic surgeries, for example, after Latarjet procedure for shoulder stabilization. The technique of open axillary nerve decompression is very popular but has a number of disadvantages: large trauma of soft tissue, severe bleeding, high rate of complications, poor cosmetic effect. Endoscopic surgical technique of decompression is an effective, less traumatic alternative to open procedures.AIM To improve the outcomes of treatment of patients with axillary nerve neuropathy.MATERIAL AND METHODS We present the outcomes of endoscopic transcapsular axillary nerve decompression in 5 patients with a clinical picture of neuropathic pain syndrome, hypoesthesia in the deltoid area, hypotrophy of the deltoid muscle, who were operated from 2018 to 2021. The mean age of the patients was 44.4±14.9. An original surgical technique of decompression, which included arthroscopy of the shoulder joint with diagnostic and treatment components and transcapsular endoscopic axillary nerve decompression in the beach-chair position, was developed and applied to all the patients. Statistical analysis was performed using the MannWhitney U test.RESULTS According to VAS-scale, the severity of pain syndrome before the surgery was 6±4.6 points, 6 months after surgery it decreased to 1.4±0.5 points (p&lt;0.05). According to DASH scale, the function of the of shoulder joint before surgery was 77,6±6,9 points, 6 months after surgery it increased to 12±5,2 points (p&lt;0.05). According to BMRC scale (M0–M5), strength of the deltoid muscle before surgery was 2±0,4 points, after surgery it increased to 4,4±0,5 points (p&lt;0.05). Range of motion in the shoulder joint before surgery was as follows: flexion 107±45,6°, extension 102±49°, external rotation 22±13,6°; 6 months after surgery: flexion 154±25,6°, extension 156±22,4°, external rotation 50±8° (p&lt;0,05). The thickness of the middle portion of the deltoid muscle according to ultrasound examination before the surgery was 7.2±1.04 mm, after surgery 11.8±1.44 mm (p&lt;0.05). All the patients (100%) during long follow-up noticed complete relief of pain and regression of neurological symptoms.CONCLUSION The achieved results allow us to characterize the method of endoscopic transcapsular decompression as a reproducible, minimally invasive and highly effective technique providing pain relief to patients, curing neurological and intraarticular pathology, thus promoting early restoration of the upper limb function in the treated group of patients.

Particular Clinical Manifestation of the Pain Syndrome in Canine Acute Gastroenteritis

Introduction. Gastroenteritis is a widespread canine pathology often complicated with the pain syndrome and characterized by development of intoxication, dehydration, haemoconcentration and such inflammatory reaction as the neutrophilic left shift leukocytosis. The aim of the work is to provide a clinical description of the canine acute gastroenteritis dependingon the pain syndrome presence and severity degree.Materials and Methods. 31 dogs sick with acute gastroenteritis were studied, they were divided into 2 subgroups: the first (n=14) – animals with the acute gastroenteritis not complicated with the pain syndrome; the second (n=17) – animals with the acute gastroenteritis complicated with the pain syndrome.Results. In dogs with acute gastroenteritis, the depression or anxiety, vomiting, diarrhea, subfebrile fever, abdominal wall tenderness on palpation, decreased skin turgor, moderate tachycardia and tachypnea were observed. When analyzing the clinical and anamnestic data, it was found that before the symptoms emerged, 65% of the animals had consumed the poor-quality or rough feed (bones). In 35% of cases, the reason of acute gastroenteritis could not be detected. Contamination and increased growth of opportunistic pathogens in the gastrointestinal tract cause the development of intoxication, dehydration and systemic inflammatory syndrome. Alimentary gastroenteritis in 54.8% of sick dogs is complicated with the acute pain syndrome, which is a predictor of the disease severity degree.Discussion and Conclusions. In dogs with acute gastroenteritis complicated with the pain syndrome, the severe tachycardia and tachypnea get developed, the number of erythrocytes, leukocytes, band and segmented neutrophils, erythrocyte sedimentation rate and hematocrit in the blood significantly increase. The perspective for the further research is foreseen in the development and clinical testing of the multimodal analgesia methods in animals with the inflammatory gastrointestinal diseases.